Date:

North Country Chamber of Commerce Membership Application for April 2009 to March 2010

Please complete this form and mail along with a check for your membership dues to:

North Country Chamber of Commerce PO Box 1

                Colebrook, NH 03576.

                                                ()         New member - $160

                                                ()          Renewing member - $160

                                                ( )        Associate member (non-business owner) - $35

                                                ()         Additional business - $35

The following information is required for the Business Directory. Your business name should go on the first line and any specialty information desired should be included on the second line, e.g. "homemade pastries." Information on Lines 1-3 only will be published in the directory. Please remember, there is a maximum number of27 characters per line.


1. BUSINESS NAME :                                                                                                                                           

2. SPECIALTY:                                                                                                                                                        

3. BUSINESS PHONE:                                                                                                                                              
 
4. MAILING ADDRESS:                                                                                                                                               

 
5. CONTACT PERSON:                                                                                                                                               

6. PHONE NUMBER: (603)                                            FAX: (603)                                   

7. E-MAIL ADDRESS:                                                                                                                                                   

8. WEBSITE ADDRESS:                                                                                                                                                

9. How do you wish to be notified for meetings? () Phone () Fax () E- Mail () None

10. Do you have any suggestions for the Chamber?