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THE CHAMBER
ECONOMIC DEVELOPMENT

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 Marianne Rustad, Vice President of Operations: marianner@carboncountychamber.org | 484-943-9669 or Kelley Andrade, Membership Engagement & Events Manager: kelleya@carboncountychamber.org | 484-274-2080

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Leave Blank

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

Instagram

Youtube

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords (enter a space between words)

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Referred By

Spouse Name

How did you hear about us?

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

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

Instagram

Youtube

Create Account

This Login is already in use

Please add your login username.

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Primary Contact Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

Instagram

Youtube

Create Account

This Login is already in use

Please add your login username.

Password *

Please add your login password.

Step 5:

Comments/Questions

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

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Corporate Sponsors & Partners

DISCOVER YOUR BOLD in Carbon County...

137 South Street, Lehighton, PA 18235

info@carboncountychamber.org

(610) 379-5000

Carbon Chamber & Economic Development

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Satellite Office: Inside Mauch Chunk Trust

Pine Point Plaza, Rts. 903 & 534,

Albrightsville, PA 18210

Disclaimer Notice: Please note that we make every effort to ensure that the copy, logo or image content uploaded to this website by Carbon Chamber employees and/or its affiliates, contractors is owned, licensed and/or used with permission by the Carbon Chamber & Economic Development Corp. (CCEDC). However, any copy, logo or image content either donated by or uploaded to this website by non-CCEDC employee, non-CCEDC affiliated or non-contracted third-parties is beyond our control, and therefore, the Carbon Chamber & Economic Development Corporation (CCEDC), its employees, affiliates and contractors are released from liability for any claims of copyright violation or financial damages caused by third-party copy, logo or image donation and/or upload to this website.