2009 Membership Application at the Mohawk Valley Chamber of Commerce, NY, New York

MVChamber Membership Application

Click Here for Printable Form Click Here for Spanish Application
Company/Organization:
Primary Contact (Name, Title):
Contact for Directory/Website: (Name, Title):
Voting Representative (Name, Title):
Address:
City:
State:	Zip:
Telephone:
Fax:
Website:
Email:
Business Category (please see directory for options):
Description of services/products:
Type of Business: Corporation Partnership Sole Proprietor LLC
I would like to join the following council(s), please notify me of the following meeting for:
Government Affairs/Economic Development Membership Publicity/Tourism Small Business
Total # Employees: F/T P/T Referred By:
Are you interested in group health insurance through the Chamber?: Yes No
Investment Schedule:
Mohawk Valley Chamber of Commerce 200 Genesee St., Utica, NY 13502 (315) 724-3151, Fax (315) 724-3177 www.mvchamber.org Our staff will contact you at the phone number above within 48 hours to gather your membership payment information. Upon Submission, I hereby grant Mohawk Valley Chamber permission to interview me and/or to use my likeness in photographs/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Mohawk Valley Chamber, in perpetuity, and for other use by the Chamber. I will make no monetary or other claim against the Mohawk Valley Chamber for the use of the interview and/or the photograph(s)/video.