Membership Application

Business Information

Company Name:

Directory Category:

Phone:

Website:

Number of full-time employees:

Number of part-time employees:

How did you hear about us?:

Year Company Started?:

Physical Address

Address:

City:

ZIP:

Mailing Address

Same as physical address

Address:

City:

ZIP:

Primary Contact Information

First Name:

Last Name:

Title:

Phone:

Fax:

Email:

Contact Preference(s):PhoneEmail

Address

Same as member address

Address:

City:

ZIP:

Membership Options

2023 Annual Membership Package (Please contact Tara Zilling for more information regarding membership dues, tzilling@northernlancasterchamber.org).

Please indicate below if we may share your business information with the general public:Yes, you may release this informationNo, please do not release this information

On the next page, you will be able to continue to PayPal to complete your transaction.

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