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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Email *
Type of Membership *
Business/Individual Membership Name *
Contact Person Name *
Mailing Address *
Please use this field if you would like mail to go to a PO Box or sent to another address than your physical address.  Please provide your full address including city and zip.
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.  Please provide your full address including city and zip.
Business Phone *
Alternate Busines Phone
Include special instructions if needed such as seasonal use or nightime use only.
Cell Phone for primary contact person
May we send limited  text alerts to the cell phone number?
Facebook Page Name
This is so the Chamber Page can share your posts to help promote your news
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.  
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.
Website Address  (for chamber website listing)
Regular business hours
Seasonal business hours
Please include date range of seasonal hours as well.
What type of promotional materials do you currently have?
Five-line description of business for Chamber website listing
Primary Businss Category
Secondary business category
Would you like a ribbon cutting for a new or expanding business?  If so, please indicate date range preferred for scheduling
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
How many years/months has your busines been in operation
Please indicate if you or your business have any special certifications, licenses, awards or honors that you would like to share.
Most unique thing about your business?
Would you be willing to serve on one of the following committees? (check all that apply)
Number of Employees  (Full time equivalent, including owners) *
Investment/Annual Dues
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