Membership Application for 2012

Myrtle Creek~Tri City Area Chamber of Commerce
P.O. Box 31
Myrtle Creek OR 97457

MyrtleCreekChamber.com
Membership Year is January 1, 2012 thru December 31, 2012. Fees due by March 31, 2012(1)

The annual membership fee is based on number of employees. Please see chart at bottom.

Please complete the requested information and return form with payment.
Accurate information is essential to help us promote your business.
Direct any questions to Chamber President Ted Romas, 541-860-5846.
Business Name:(1)

Representative:

Street Address:

Mailing Address:
Phone Number:

eMail:
 Fax Number:

Website:(2)
(1)Note: All active members will be listed in Member Directory, however, full payment must be received by
  February 15, 2012 in order to include your business as a 2012 Chamber member in printed brochures, mailings and
  other promotional materials. Otherwise, the membership fee must be received by March 31, 2012 to continue to
  receive all other benefits of membership. After March 31st, dues are prorated by month of application.
(2)NEW: As a FREE benefit of Chamber membership, the Chamber website at myrtlecreekchamber.com will
  provide a link to your business website in the Member Directory.

Annual Membership Dues
Private Individual
1 to 5 Employees
6 to 14 Employees
15 to 24 Employees
25+ Employees
Web Link Fee:
 $50
$50
$60
$70
$100
FREE
New members are welcome to join any time. Dues are prorated by month after March 31st. Formula: Divide your annual dues (above) by 12, then multiply by FULL calendar months remaining in year, then round off to lowest dollar amount.
Payment Enclosed:   Amount: $_________________  Check # ____________   Date: ____________________


Cash Received (do not mail cash): Amount:  $_______________  Date:_____________  By: ___________________________