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Floyd Chamber Membership Application
This form is for new membership information or to provide additional information for existing members. For new memberships...after the form is submitted, a membership dues invoice and information on next steps will be sent to the email address listed as the primary chamber contact on the form. The invoice will have the option to pay online.
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* Required
Email
*
Your email
Type of Membership
*
Choose
Business (most will fall into this category)
Industry (select if doing manufacturing/production on large scale)
Individual (this is for people who are retired or have no business interest to promote)
Firm
Farm
Nonprofit
Business/Individual Membership Name
*
Your answer
Contact Person Name
*
Your answer
Mailing Address
*
Please use this field if you would like mail to go to a PO Box
Your answer
Street Address
Please use this field for physical address (if the same as mailing address, type in "Same") This info will be used for website listing unless business is by appointment only or an individual membership.
Your answer
Business Phone
*
Your answer
Alternate Busines Phone
Include special instructions if needed such as seasonal use or nightime use only.
Your answer
Cell Phone for primary contact person
Your answer
May we send limited text alerts to the cell phone number?
Choose
Yes
No
Facebook Page Name
This is so the Chamber Page can share your posts to help promote your news
Your answer
Email Address for general business contact
*
This can be an "info@...." address but it cannot be used for e-newsletter list so alternate email needed as response for next question.
Your answer
Email for primary Chamber contact
*
This is for chamber newsletter contact, especially if general email cannot be used due to spam controls because it is an "info@..." email address.
Your answer
Website Address (for chamber website listing)
Your answer
Regular business hours
Your answer
Seasonal business hours
Please include date range of seasonal hours as well.
Your answer
What type of promotional materials do you currently have?
Rack Cards
Brochures
Business Cards
Other:
Five-line description of business for Chamber website listing
Your answer
Primary Businss Category
Your answer
Secondary business category
Your answer
Would you like a ribbon cutting for a new or expanding business? If so, please indicate date range preferred for scheduling
Your answer
Do you have something new and different coming up that you'd like us to know about and help promote? (expansion of services, new service, new location, significant anniversary, new management, etc.) Please provide details below
Your answer
How many years/months has your busines been in operation
Your answer
Please indicate if you or your business have any special certifications, licenses, awards or honors that you would like to share.
Your answer
Most unique thing about your business?
Your answer
Would you be willing to serve on one of the following committees? (check all that apply)
Marketing
Special Events
Finance
Membership
Community Development
Number of Employees (Full time equivalent, including owners)
*
Your answer
Investment/Annual Dues
Individual $35 (This category is for people who are retired or have no service, company, or organization to promote.
Non Profits $50
0-5 Employees $85
6-20 Employees $175
21-45 Employees $250
45+ Employees $400
additional business (one third the rate for second business with primary business under same ownership being the higher rate)
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