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Chamber Online Registration Form (Once you you have submitted this form you will be contacted) Name of Business: Type of Business: Physical Address: Mailing Address: City: State / Zip:    Phone / Fax:    Employees Count: Full-Time   Part-Time: Primary Contact Name: Position: Email Address: Secondary Contact Name: Position: Email Address: WebSite Address 1-5 Employees (Two representatives receiving mail) $175.00 6-25 Employees: Full-Time / Part-Time (Two representatives receiving mail) $250.00 26-50 Employees (Two representatives receiving mail) $350.00 51 or more Employess (Two representatives receiving mail) $600.00 Non Profit Organization (Two representatives receiving mail) $100.00 Individual Memberships (Public employees, retirees, non-business only) $100.00 Farmers (Primary income source must come from farming) $100.00