Greater Hampstead Chamber of Commerce Membership Application
www.hampsteadchamber.com

I/we apply for Membership in the Greater Hampstead Chamber of Commerce, dedicated to promoting the economic and civic growth of the Greater Hampstead market.

I/we understand that this Membership Application is subject to approval by the Board of _ Directors, Greater Hampstead Chamber of Commerce and that the fee submitted herewith will be refunded should this Application be declined.

Upon approval this Membership shall remain in effect until, and/or unless, [1] I/We resign in writing, to the Board of Directors, Greater Hampstead Chamber of Commerce, Post Office Box 211, Hampstead, NC 28443, or, [2] Annual Dues are in arrears and this Membership is voided as provided for in the By Laws of the Greater Hampstead Chamber Commerce, or, [3] The Board of Directors, Greater Hampstead Chamber of Commerce vacate this Membership due to activities or practices of the business entity, or staff, deemed to be inconsistent with the values of the community.

Registered Business Name

(d/b/a name if applicable):  _________________________________________

Employees: ____

Person to contact

Name and Title: ___________________________________________________

Location (Number and Street): _______________________________________

City, State and Zip Code: ___________________________________________

Mail address (If different from above): __________________________________

Telephone: ___________________ Fax: ___________________

Email: _____________________________

Website URL: ___________________________________________________

Products or services offered: _____________________________________ Category ____________________________ (select from member's page)

Membership Applied For

Full $ ______________ Booster (Individuals only) $ _________

Authorized Signature: __________________________________ Title and Date: _______________________________________