Membership Application - Fort Collins Area Chamber of Commerce

* Required
   
Organization Information (to be displayed online)
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Year Established *
Number of Employees (Local) *  
Number of Employees (Total) *  
Is your business primarily women, veteran, or minority? *
Average age of owner(s) *
Main Contact
First Name *
Last Name *
Address 1
Address 2
City
State
Zip
Title
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Referred by
How did you hear about us?
What is your reason for joining? (choose one) *
Areas of Interest
*Check all that apply
Business Advocacy
Marketing & Sponsorship Opportunities
Professional Development & Education
State & Federal Legislation
Transportation
Water
Workforce Development
Other
Membership Investment
Membership Level: *
Primary Directory Category *
   
$ 
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees (Local)
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
Additional Directory Categories
  • Primary Directory listing is complimentary
  • Additional member level based complimentary listing categories:
    • Network Plus: 1 additional category
    • Promotional:
    • Executive:
    • Corporate:
    • Platinum: 4 additional category
  • After the complimentary categories, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
$ 
Enhanced Membership ($50):
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Expiration Date
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address
Please click submit only one time.  The transaction may take several seconds.