Jay County Chamber of Commerce

Chamber Membership Form

To become a Member please fill in the form below. If you wish to print the form and fill it out by hand, instead of submitting it online, please Click here
*Fields marked with are required.**
Company:*
Contact Person:*
Title:*
Contact Person Email:*
Phone number of business:*
Fax number of business:*
Street Address:*
City:*
State:*
Zip:*
Website:*	(e.g. your-site.com )

Type of Service/Product ?*

Year Formed ?*

Number of full time employees ?*

Would you like to Participate in the gift Certificate Program ? *

Who recommended the Chamber ?*

Person submitting this info ?*

Email of person submitting this info ?*

Comments:*


If you wish to print this page click here

Number of Employees

 1-3   $165     11-20 $385   41-50 $550      71-80 $880     Utilities         $605 Min   
 4-6   $275     21-30 $440   51-60 $660      81-90 $990     Not-for-Profit    $55/110 Min
 7-10  $330     31-40 $495   61-70 $770      91-100 $1100   Individual        $55 Min

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