Amherst County Chamber of Commerce

2008 Membership Application

Print and mail this form along with check to:

Amherst Co. Chamber of Commerce
PO Box 560
Amherst VA 24521

Join us with an eager and creative spirit dedicated to improving the commerce industry in our county. We stand ready to hear the issues that concern you as a business person in Amherst County. Don't be left behind! Your business is our business!

In order to give the organization a steady and dependable income on which to plan its community development programs, it is hereby agreed this membership is to be continuous unless cancelled in writing. All members are invoiced during the month of January to coincide with the Chamber's fiscal year.

The undersigned hereby applies for new membership based on the number of employees (_____) and agrees to pay the Amherst County Chamber of Commerce $________ for January through December 2008 membership. After March 31st, call 434-946-0990 for pro-rated dues.

Please enter the information requested below clearly, accurately, and completely so we will have an up-to-date record in our files and on our web site. Your accuracy helps us to distribute correct information when answering the hundreds of referral and relocation requests we handle each year.

* Please refer to the following chart for your dues amount *

Employees	Dues	Employees	Dues
1 (Individual)	$61	26-50	$232
2-5	$88	51-100	$292
6-10	$116	101-200	$348
11-15	$176	201-300	$408
16-25	$204	over 300	$463

Note: Non-profit and government orgizations receive a 50% discount of the No. Employees/Dues amounts above.

* Please use the following chart to provide us with your business information *

Company Name
Mailing Address
Street Address
City	State	Zip	No. Employees
Phone	Fax		Other
Web Site Address		Email
Contact Person		Title
Owner/President		Business Type
Signature		Title	Date
Please contact me to help on a committee or yearly event. (Check Yes or No) Do you currently have a Membership Plaque?			Yes Yes	No No