Membership Application




 
Please fill out the following information, and we will contact you about joining the chamber!
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Membership shall be continuous unless cancelled in writing by the member. Dues to the Rogers-Lowell Area Chamber of Commerce are not deductible as a charitable contribution for income tax purposes but may be deductible as an ordinary and necessary business expense. A portion of dues (9%) however is not deductible as an ordinary and necessary business expense to the extent that the Chamber engages in state or federal lobbying.
   
Organization Information (to be displayed online)
Organization Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Do you want your physical address listed in web and print directories?
Yes No
Preferred Communications?
Email Mail
Optional: Minority-Owned?
Yes No
Description of your business (30 words or less)


Reason for Joining
Community Involvement/
Increasing Visibility
Marketing/Advertising/
Publicity Opportunities
Political & Legislative Advocacy
Economic Development/
Creating Jobs &
Business Opportunities
Members Only Benefits/
Special Offers
& Services
Small Business Resources/Information & Ideas
Education/Professional
Skills Development
Networking/New
Business Contacts
Supporting the Chamber's Mission/Improving Quality of Life in NWA
Other:
If not listed above, please provide your reason for joining:
Membership Investment
Membership Type: *
Primary Directory Category *
Number of Full Time Employees:  
Number of Part Time Employees:  
Number of Rooms (Accommodations):  
Number of Associates (Realtors, Attorneys):  
Millions in Assets (Financial Institutions):  
Additional Locations ($25 each):
   
 
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
additionalLocations
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
tempValueForDropDown1
Additional Directory Categories
  • Primary Dirctory listing is complimentary
  • Up to two additional Dirctory listings are complimentary
  • After two, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Seats (Restaurants):  
Number of Locations ($35/add. location):  
Enhanced Membership ($50):
$ 
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Membership shall be continuous unless cancelled in writing by the member. Dues to the Rogers-Lowell Area Chamber of Commerce are not deductible as a charitable contribution for income tax purposes but may be deductible as an ordinary and necessary business expense. A portion of dues (9%) however is not deductible as an ordinary and necessary business expense to the extent that the Chamber engages in state or federal lobbying.
Credit Card Information
Credit Card Type *
Credit Card Number *        
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address

Please type the above letters for verification purposes.
Please click submit only one time.  The transaction may take several seconds.