Firm Name:

Billing Address:

City, State & Zip:

Mailing Address:

City, State & Zip:

Primary Mailing Recipient:

  Check one:      Mr.     Ms.

Phone:

Dedicated Fax:

*Email: 

Join Date:

Preference of Communication:        Dedicated Fax      Email

Web Address:

# of Full-time  Local Employees:

Business Classification
(as shown in the yellow pages):

Additional Classification(s)
(Two classifications included in membership; each additional one thereafter $50):       

Additional Name(s)/Title(s)/Email address(es) for Directory Listings (up to three):

  1.  Annual Investment (per guideline)

 $

  2.  Processing Fee

 $

  3.  Additional Classification(s) @ $50ea.

 $

  4.  Total (Cash/Check/Charge)

 $

     
MC  VISA  Card #   Exp. Date

Signature _____________________________________________
(Note: This membership application must be signed by an authorized person with the member company. The company is the member of the chamber. Participants are the representatives. Anyone employed by the member is eligible to participate with your permission.)
*    Note:  Communication is via email unless specifically requested
       otherwise.

I acknowledge that the Overland Park Chamber of Commerce may communicate with me via fax or email about the chamber and chamber member products, programs, discounts, sponsorships, registration deadlines and services.

Signature _____________________________________________

The federal Government Requires The Chamber To Inform You:

Please fill out this form completely, print it out and send it, along with a check for your fees, or provide credit card information and fax to: