Member

The Farmville Area Chamber exists to support you and your business as you strive for success. There's no doubt that you belong here. Information and knowledge, opportunities for networking and personal enrichment...they're all here for you.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Business Description (200 char max):

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name:

Last Name:

Phone:

Fax:

Email:

Contact Preference:

Email Phone

Password:

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Contact Member: $300.00
1 Business Membership with 1 Contact Person (1 Year Membership) 2nd Business: $200.00
Each additional business owned by a current Contact Member (1 Year Membership) Associate Member: $165.00
Additional Members from a Contact Member (1 Year Membership) Individual : $140.00
Individual Member NOT associated with any Business *Must meet specific Chamber qualifications to be considered an individual.

Additional Opportunities:

We will contact you with additional information.

Membership Lunches : $50.00
All membership lunches for the year of membership

Payment Option:

Bill me Charge my credit or debit card

Print Application

Member Application

Mailing Address

Address

Address