Columbus Area Chamber of Commerce

For Members: Membership Application

Application For Membership


Complete the online form below or print the application, fill it out, and fax it back to us.

Personal Profile (Primary Contact)
	*Your Name

	*Your Email

	*Your Phone Number

Additional Contacts:
	Additional Contact Name 1)
	Email

	Name 2)
	Email

	Name 3)
	Email

	Name 4)
	Email

Company or Affiliation
	*Company Name

	*Street Address

	Street Address 2

	*City

	*State

	*Zip

	Website

Additional Company Information
	*Date Founded

	*Number of Owners

	*Form of Ownership

	*Company Description

	*Directory Listing

	*Number of Employees	Professionals

		Full-Time Employees

		Part-Time Employees
		_________________________

		Total Number of Employees

Calculate Your Investment

	*Investment Category

	Base Investment

	Professionals		( per employee)

	Full-Time Employees:		( per employee)

	Part-Time Employees		( per employee)

	One-Time Admin Fee	30.00
	Other Billing Options
		_________________________

	Total Annual Investment

Billing Information (all fields required if paying by credit card)
	Membership Investment Due


	Card Type

	Name on Card

	Card Number

	Expiration Date

	Billing Street Address

	Billing City

	Billing State

	Billing Zip

Other Billing Options

		Please invoice my business.

		or Call 812.379.4457 to pay by credit card via phone