New Member Application

Please fill out the following form completely. Join online immediately with credit card:

Your Business Info

* Indicates the field is required.

Business Name *
Doing Business As
Pref Communication
Date Established
Full-Time Employees
Part-Time Employees
Business Code *
Business Description
Referred By

Enter your Company Email and Website:

E-mail Address *

Web Site Address

Create Your Username and Password Below
This will enable you to take advantage of member benefits.

Your Main Rep Info Here

Salutation
First Name *
Last Name *
Web Username *
Web Password *

Enter your Email Address :

E-mail Address *

Enter your Mailing Address

Mailing Address

Address - LN1
Address - LN2
City
County Twp/Boro
State
ZIP

Street Address (Complete only if different from mailing address)

Street Address: (Complete only if different from mailing address)

Address - LN1
Address - LN2
City
County Twp/Boro
State
ZIP

Phone

Phone 2 *

Fax *

I understand that by providing my mailing address, email address, telephone number, and fax number, I consent to receive communications sent by or on behalf of The Business Council via regular mail, email, telephone, or fax.

New Membership Investment

Enter your annual dues amount based on the below investment schedule

TOTAL :

$250.00 Base rate for all businesses.

$250.00 Retail/Wholesale/Manufacturing/Hospitals (plus $2.50 per full-time
employee, and $1.25 per part-time.)

$250.00 Not-for-Profit Associations

$250.00 Banks/Financial Institutions (plus $21 for each million of assets up
to $100 million or $16 for each million over $100 million

$250.00 Hotel/Motel (plus $4 per room (with $2.10 for each room going to the
Visitors Bureau).)

$250.00 Government Agencies (plus $1.00 per full-time employee, and $.50
per part-time employee)

$250.00     Licensed Proffesional Office; Architect, Attorney, Chiropractors,
                CPA, Dentist, Doctor, Engineering, Insurance,
                Investment/Business/Mortgage Brokers, Investment/Financial,
                Opticians, Real Estate, Veterinarians (plus $5 per agent/broker/
                licensed professional and employee. (Each licensed professional
                will be listed in the Membership Directory.)

$250.00 Utilities (plus additional fee determined upon service area. Minimum
membership dues of $1,000)

$250.00 Newspaper (plus .03675 multiplied by the average daily circulation.)

Please contact Nancie English in the Membership Department (570) 320-4210, email Nancie at nenglish@williamsport.org, or call 570-326-1971 if you have any questions.

Your membership fees may be deductible as a business expense.

Williamsport/Lycoming Chamber of Commerce

New Member Application