Member Application

Chamber of Commerce

Member Application

You can submit your application to the Liberty-Dayton Area Chamber of Commerce using the form below. After reviewing your application, a representative from the Chamber will contact you. As an alternative, you may also download and print a copy of the member application here (in Adobe PDF format). Complete the form and return it to the Chamber by fax (936-336-1159) or in person (1801 Trinity Street in Liberty).

We subscribe $ Please bill us

Check one (billing preference):
Monthly
Quarterly
Semi-Annually
Annually

Date Business Started (ie. 05/28/08)
Number of Full-Time Employees Part Time

Firm Name

Street Address

Mailing Address

City

State

Zip Code

Phone Fax Cell
(please include area code for each telephone contact)

Designated Representative

Title

Preferred Chamber Directory Category

Web Site

E-mail

Signed by

Date (ie. 05/28/08)
Title

Your application will be sent to the Chamber via e-mail.
Please ensure the information in each field is correct before clicking the "Submit" button. To clear the entire form, select "Reset".

Note: Subscriptions are payable in advance and are continuous unless canceled in writing in
advance of the due date.

Business Membership - Annual Base Dues are $180.00 per year, which includes the first 10 employees. Each employee over ten - $5.00 each full time employee, $2.50 each part-time employee.
Financial Classification - based on assets (to be negotiated).
Apartments, Motels, Hospitals & Convalescent Hospitals - $180.00 per year + $5.00 per unit based on average annual occupancy.
Utility Companies - to be negotiated.
Individual Membership - $75.00.