Online Application

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ONLINE APPLICATION

Please submit a membership application by completing this form and then mailing payment to the Chamber's business office.

MEMBERSHIP APPLICATION

Private Citizen or
Company Name: Phone:

Mailing Address: Fax:

City: State: Zip:

Physical Address:

City: State: Zip:

e-mail address:

Company Representative(s) (list phone & fax if different from main numbers)
1. 2.

Phone: Phone:

Check appropriate category (annual membership)
$48 Private Citizen/Family/Non Profit
$130 Small Business (1-9 employees)
$255 Large Business (10+ employees)
$505 Corporate Sponsor

For your listing in the Membership Directory:
Type of Business (primary):

Other applicable categories:

Please send payment to:
Madison the City Chamber of Commerce
P.O. Box 544, Madison, MS 39130-0544

You may pay by check or credit card.

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