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Business/Organization:
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Date Established:
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Mailing Address:
(*Include street address)
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City:
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State:
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Billing Address:
(if different)
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City:
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State:
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Phone:
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Fax:
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E-Mail:
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Web Site:
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Person to Receive Mailings:
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Nominated for Membership by:
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School District:
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Township or Borough:
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Manufacturing SIC Code:
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Contact for Human Resources:
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Contact for Environmental Compliance:
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Does your business import/export?
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Please select up to five different member codes that pertain to your business.
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Member Code 1:
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Member Code 2:
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Member Code 3:
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Member Code 4:
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Member Code 5:
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Why are you joining the Tri County Area Chamber of Commerce?
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Please provide a forty word description of your company.
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Number of Full-Time Employees:
(or equivalent)
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Amount of Dues:
(click here for rates)
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Administrative Fee:
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$25.00
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Total Amount:
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PAYMENT OPTIONS
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Credit card:
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Cardholder name:
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Card number:
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Expiration date:
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CVV:
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