MEMBERSHIP APPLICATION

Click here for printable version.
Company Name: 
Type of Business:

Address: 
City: 
Zip: 

Phone: 
Fax: 

Email 1: 
Email 2: 

Web Address: 
Number of Employees: 

Referred By: 

Annual Membership Dues (12 month membership)

Corporate
1-4 Employees
5-19 Employees
20 or more Employees
Chairman's Club
Presidential Advisor
$200
$300
$500
$1000 (available to companies of all sizes)
$2500 (available to companies of all sizes)
 .
Basic membership includes listing of one representative in the membership directory. At the level of 20 or more employees, membership includes listing of an additional representative at no charge. Additional representative(s) may be included at a cost of $35 per representative.
Name(s) of representatives:



 
Non-profits: Check $200 (regardless of the number of employees) 
Name(s) of representatives:



 
Credit Card Information:
Complete the following.
Remember to sign if mailing
Check (payable to Oldham County Chamber of Commerce)
Visa
Mastercard
Account Number: Exp.date
Name on Card
Total Cost:


Press Submit or Mail this form with payment to:
Oldham County Chamber of Commerce
P.O. BOX 366
LaGrange, KY 40031

For additional information, or if you have questions, please call or fax:
 Phone: 502.222.1635
Fax: 502.222.3159 (Attention: Member Services Director)