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Member Application

Thank you for your interest in joining the Carbon Chamber & Economic Development Corporation's growing Membership! We offer various membership packages to meet your business needs.

Please fill out the membership application to the best of your ability so that we may better serve you. The red asterisk (*) indicates that the field cannot be blank.

Questions? Contact Jessica Kohutka, Member Relations Manager: jkohutka@carboncountychamber.org | 570-952-5453.

Step 1:

Member Info
Please add your company name.
Please add your company phone number.
Please add a valid email.
Physical Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Mailing Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses

Step 2:

Additional Info
Please add your company description.
Please select a directory category.
Please add your number of full-time employees.
Please add your number of part-time employees.

Step 3:

Primary Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses
Create Account
Please add your login password.

Step 4:

Billing Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses
Create Account
Please add your login password.

Step 5:

Payment Option
Please complete the Captcha

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