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   $175     11-20 $405   41-50 $575      71-80 $925     Utilities         $635 Min   
 4-6   $290     21-30 $460   51-60 $690      81-90 $1040    Not-for-Profit    $60/115 Min
 7-10  $345     31-40 $520   61-70 $810      91-100 $1155   Individual        $60 Min

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