Joplin Area Chamber of Commerce Membership Application
YES! I want to Join. My Annual investment is enclosed with this application.
Business Name
Address 1
Address 2
City
State
Zip Code
Phone Number
Fax Number
Website
Primary Contact
Title
E-Mail Address
Additional Contact
Title
E-Mail Address
Type of Business
Number of Full Time Employees
Number of Part Time Employees
Total Number of Employees
Referred By
What made you decide to join the Chamber?
What do you expect to get from your Chamber membership?
Is there anyone you would like to refer for membership in the Chamber?
Payment Information
	Credit/Debit Card
Credit Card Number
CVN # (3 digit code from back of card)
Expiration Date (MM/YY)
	Check for Full Investment Amount
	Monthly Auto Debit (Auto debit Agreement Required)
Investment Schedule
1-5 Employees = $ 307.00
6-10 Employees = $399.00
11-25 Employees = $484.00
26-50 Employees = $576.00
51-75 Employees = $672.00
76-100 Employees = $805.00
101-150 Employees = $988.00
151-200 Employees = $1,210.00
201-250 Employees = $1,340.00
251-300 Employees = $1,451.00
301 - 400 Employees = $1,690.00
401-500 Employees = $1,991.00
501 - 600 Employees = $2,223.00
601 - 700 Employees = $2,663.00
701 - 800 Employees = $2,883.00
801 - 900 Employees = $3,112.00
901 Employees and up = $3,406.00
Annual Investment Amount based on employee count
Plus One time Enrollment Fee - $30.00
Equals Total Investment
Financial Institutions, professionals, hotel/motel, apartments, individuals, associate and Non Profit rates will be provided upon request. Investment amount will be verified before your credit card is charged.
Thank you for joining the Joplin Area Chamber of Commerce! Your Membership packet will be delivered to the address listed in your application
	I authorize JACC to send communicaitons via e-mail
	I authorize JACC to send communications via fax
Please contact Ginger LaMar, Membership Director at 417.624.4150 or at glamar@joplincc.com if you have any questions.