Topic Survey

Member Information

Organization

Address Line 1

Address Line 2

City

State

Zip

Area Code/ Phone

Fax

Email

Web site

Billing Address (if different)

Address Line 1

Address Line 2

City

State

Zip

Key Contact

First Name

Last Name

Title

Additional Contacts

Name 1

Name 2

Yearly Investments

Number of Employees

Full Time

Part Time

Investment Amount
(see Investment Information to calculate your Investment)

Acknowledgment: In consideration of the work of the Superior/Douglas County Chamber of Commerce, I/We agree to invest for the balanced growth of our area according to the Board of Directors approved business plan and agree to the above Investment Fees.

Signature

Date

Directory Information

The information contained in the following section will be used in the Chamber Membership Directory and on the Chamber Website

Category 1

Category 2

Category 3

25 Word Description

Event & Committee Involvement

I am interested in learning more and/or participating in the following events & committees:

Ambassadors

Education Committee

Government & Community Affairs Committee

Marketing Committee

Membership Committee

Play Day Committee

Superior Leads

Superior Taste Committee

Youth Leadership

Website Opportunities

Great Banner Ad Website Opportunities!

Want more information

Yes, notify me with more information.