Please complete the form below. Someone from our member relations team will contact you shortly. If you have any questions, please contact the Chamber at 337-233-2705.
 

Member Application:

* Company Name:  
* Phone:  
Website:
Business Description (200 char max)
 
Referred By:
 
* Physical Address:  
* City/State/Zip:  
Country:
 
* Mailing Address: Same as physical address
* City/State/Zip:
Country:
 
* Business Category:
* Employees: Full-time:      Part-time: 
Comments/Questions:
 
 

Primary Contact Information:

* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
Fax:
* Email:  
Contact Preference: Email  Phone
 
* Address: Same as Company Address
* City/State/Zip:
Country:
 
 

Billing Contact Information:
Same as Primary Contact
* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
Fax:
* Email:  
Contact Preference: Email  Phone
 
* Address: Same as Company Address
* City/State/Zip:
Country:
 
 
Membership Package:
Level One: $325.00
1-10 Employees; 2 Representatives Provided
Level Two: $450.00
11-25 Employees; 3 Representatives Provided
Level Three: $600.00
26-45 Employees; 4 Representatives Provided
Level Four: $800.00
46-100 Employees; 6 Representatives Provided
Level Five: $1,000.00
101-250 Employees; 8 Representatives Provided
Level Six : $1,450.00
251-500 Employees; 10 Representatives Provided
Level Seven: $2,000.00
501+ Employees; 12 Representatives Provided
Additional Fees:
Administrative Fee
$25.00
Additional Opportunities:
We will contact you with additional information.
Additional Member cards
Each representative receives a Membership Card. You can purchase additional cards for other employees.
Payment Option:
Bill me
Charge my credit card
 
 
Submit Application:
Enter the CAPTCHA words, then press the Submit Application button.
  Submit Application Print Application
 

   

 

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