Chamber of Business and Industry of Centre County | State College, PA

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the chamber of business & industry
of centre county

Application

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Organization Information (to be displayed online)

Business Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Website

15 word description of Business.

Main Contact

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

Top 3 Reasons You Joined

Select additional directory categories below by holding the "CTRL" key

Referred By

Choose one of the following:

Membership Investment

Membership Type

*No business promotion

Primary Directory Category

Number of Full Time Employees

Number of Part Time Employees

Enhanced Online Listing ($50)

Annual Membership Investment

Additional Items

One-Time Application Fee

Total

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Tax

Additional Categories Cost

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

Millions in Assets

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Non Profit

Govt Agency Office

Individual Realtor

*IndividualRetiree

Individual Elected Official

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Payment Type

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 MastercardVisa

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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the chamber of business & industryof centre county

Application .wc-legacyPageTitle, .GeneralHeader, .HeaderStyle1, #wc-eventDetailsPageTitle, #wc-eventRegistrationPageTitle { display: none!important; }

the chamber of business & industry
of centre county

Application