Member Application

Thank you for your interest in joining the Carbon Chamber & Economic Development Corporations growing Membership! Please fill out the membership application to the best of your ability so that we might better serve you. The red asterisk (*) indicates that the field cannot be blank.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Referred By:

How did you hear about us?:

Would you like to host a ribbon cutting or on site event?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Pinterest Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Gold Enhanced Member Profile: $250.00
This is an added value item - a $225 fee will be added to your regular membership rate annually. Add your logo next to your company info, expanded description of 1,600 characters instead of 200, bulleted highlights, additional site links, slideshow of additional photos or video, enhanced map features, priority placement in business directory listing, logo/image next to listing, 200 character description under company name on Search Results, and web site link above phone number on Search Results. $225 /1 yr

Payment Option:

Bill me Charge my credit or debit card