Membership Application

Please fill out completely.

Company/Business Name: __________________________________________________________________________

Mailing Address: _________________________________________________________________________________

Physical Address: ________________________________________________________________________________

Telephone: _________________________________ Fax: __________________________ Other: _________________

Representative Name: ____________________________________ Title: _____________________________________

Email Address: ________________________________________ Web Address: _______________________________

Type of Business/Company: ________________________________ Number Employed: _________________________

Would a representative of your Company consider serving on a standing Committee? If yes, please circle any of the following:

1. Agriculture                                                      6. Membership

2. Beautification                                                  7. Programs & Events

3. Catfish Festival                                               8. Retail Merchants

4. Industrial Development                                 9. Tourism

5. Christmas Parade                                           10. Infrastructure

In your opinion, what should be the primary goal of the Chamber of Commerce?
________________________________________________________________________________________________

What suggestions would you like to offer the Chamber of Commerce?
________________________________________________________________________________________________

Would you like to sponsor a Chamber Luncheon of one fee of $75.00 for a month?
__________________________________________ If so, what month? _______________________________________

How would you like your name to appear to be recognized for a Luncheon sponsor? ________________________________

Please fill out a check according to the correct due structure below and mail back with application to: Chamber of Commerce
PO Box 408, Morgantown, KY 42261.

Due Structure:

Non-Profit Civic Organization (Limited To Local In County)                                      $25
Associate Member (Individual such as farmer, teacher, retired person, etc.)           $40
Business: (Based upon the number of employees per company)
Small Business I  (1-5 employees)                                                                                    $75
Small Business II (6-10 employees)                                                                                  $100
Small Business III (11-20 employees)                                                                               $150
Large Business I (21-50 employees)                                                                                 $250
Large Business II (51-100  employees)                                                                            $350
Large Business III (101 employees & over)                                                                    $400
Govermental Agencies                                                                                                       $100

Your Signature ______________________________________________________

Dues Investment: ________________________ Check _______________________

Date Sent: __________________________