The Humboldt
County Chamber of Commerce
APPLICATION FOR MEMBERSHIP
Name of Business:
__________________________________________________________________________
Business Owner(s):
_________________________________________________________________________
Manager (if any)
____________________________________________________________________________
Mailing Address:
___________________________________________________________________________
___________________________________________________________________________________________
Physical Address:
__________________________________________________________________________
Telephone: ___________________________________ Fax:
________________________________________
Email: ___________________________________ Website:
_________________________________________
Number of full-time employees (total hours worked by all employees divided by
40):__________
Business Description:
______________________________________________________________________
___________________________________________________________________________________________
I am interested in: ___ Chamber Checks ___ Hosting a Mixer.
Signature ____________________________________________________ Date:
________________________
Amount enclosed for membership dues:
_____________________________________________________
By signing above, the applicant agrees to an annual investment of $___________. The
membership investment is payable in advance and is considered continuous until cancelled
in writing. There are no refunds of dues paid. |
INVESTMENT SCHEDULE
Individual
$50
1-5 employees
$100
6-10 employees
$125
11-15 employees $175
16 - 25 employees $200
26 - 50 employees $300
51 - 75 employees $400
76-100 employees $550
100 or more employees $750 |
Please return your application and investment to:
The Humboldt County Chamber of Commerce
30 West Winnemucca Blvd.
Winnemucca, Nevada 89445
For more information, call
(775) 623-2225 |