Wabash County Chamber of Commerce

» Membership Application

Your Name:

Business:

Address:

City, State, & Zip:

Phone:

Fax:

E-mail:

Web Address:

Date Business Started:

Date:

Type of Business

Ownership:

If other, please describe:

CEO:

Please give a brief (four lines max.) description of your business to be included on the website and in the membership directory.

Please read the form carefully and fill out only the sections that apply to your company.

1. Business Class (Required)

If your business is in the Commercial & Industrial category, please indicate the number of employees below. All other applicants, ignore:
Commercial & Industrial Rates
0-2 Employees (Investment $220.00) 3-5 Employees (Investment $239.00) 6-10 Employees (Investment $260.00) 11-15 Employees (Investment $323.00) 16-20 Employees (Investment $352.00) 21-25 Employees (Investment $405.00) 26-30 Employees (Investment $461.00) 31-35 Employees (Investment $497.00) 36-40 Employees (Investment $516.00) 41-45 Employees (Investment $537.00) 46-50 Employees (Investment $562.00) More than 50 Employees ($562.00 Plus $2 per employee over 50) # of Employees:

If your business is in the Financial Institution category, please indicate total number of employees. All other applicants, please ignore:
Financial Institutions
Base Investment =	$525.00
Full-time Wabash equivalent: X $35.00 =
Total Contribution =

If your business is in the Utilities category, please indicate total number of employees. All other applicants, please ignore:
Utilities
Base Investment =	$275.00
Full-time Wabash equivalent: X $35.00 =
Total Contribution =

If your business is in the Academic category, please simply fill in the amount of employees. All other applicants, please ignore:
Standard Contribution is $100.00
0-2 Employees (Investment $120.00) 3-5 Employees (Investment $139.00) 6-10 Employees (Investment $160.00) 11-15 Employees (Investment $223.00) 16-20 Employees (Investment $252.00) 21-25 Employees (Investment $305.00) More than 25 Employees ($350.00) # of Employees:

If your business is in the Second/Related Business category, all information has been provided for you. All other applicants, please ignore:
Second/Related Business
Base Investment =	$125.00

If your business is in the Not For Profit & Individual Associate [No Storefront] category, please simply fill in the amount of employees. All other applicants, please ignore:
Standard Contribution is $100.00
0-2 Employees (Investment $120.00) 3-5 Employees (Investment $139.00) 6-10 Employees (Investment $160.00) 11-15 Employees (Investment $223.00) 16-20 Employees (Investment $252.00) 21-25 Employees (Investment $305.00) 26-30 Employees (Investment $361.00) 31-35 Employees (Investment $397.00) 36-40 Employees (Investment $416.00) 41-45 Employees (Investment $437.00) 46-50 Employees (Investment $462.00) More than 50 Employees ($462.00 Plus $2 per employee over 50) # of Employees:

CHECK IT OUT! NEWEST BENEFITS FOR GOLD SPONSOR INVESTMENT LEVEL: - $500 for Special Designation of the HIGHEST LEVEL Chamber sponsor. Your sponsorship is noted on Membership Lists, Directories (including the Web-site), Newsletter, Chamber page in Wabash Plain Dealer, and in Chamber publicity. FREE LARGE ROTATING BANNER AD on the Chamber web site, Direct Links with map capabilities to your web site, Special Signage at Activities, $100 in Chamber Bucks, and preferential positioning. This Gold Sponsorship fee is on top of your regular membership investment found below.

If you wish to become a gold member please check the box to the left.

NOTE: Currently there is a dues investment ceiling of $1,960.00 for all membership categories.

TOTAL AMOUNT BEING SUBMITTED

NOTE: If you wish to pay by credit card just click "Send Membership Application" and it will take you to a page to fill in your credit card information etc.

Pay by check?

Invoice me?

Please indicate if you would like a Wabash County Chamber of Commerce representative to contact you to confirm receipt of this application.

YES
NO

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