Join Us - Greater Lehigh Valley Chamber of Commerce

Please fill out the form below so that we might better serve you.

Organization Information

Company Name:

Primary Contact First Name:

Primary Contact Last Name:

eMail:

Address Line 1:

Address Line 2:

Address Line 3:

City:

State:

Zip:

City / Borough / Township:

Phone:

Cell Phone:

Website:

Additional Contacts

Additional Information

Facebook Page URL:

Twitter URL:

Instagram URL:

YouTube URL:

Yelp URL:

Referred By:

Primary Directory Category

Additional Directory Category ($100)

Business Description:

Keywords:

Do you provide any special offers to members?
If so, please describe:

My business is (check all that apply):

Minority Owned	Female Owned
Downtown Business	Non-Profit
Veteran Owned	Hispanic Owned
Black Owned

Please list all of your interests

How did you hear about the Chamber? (Please, check all that apply.)

Chamber Member	Website
Newspaper	Television
Radio	Attended an Event
Billboard	Broker
Blue Cross	Other

Membership Investment

Membership Type:

Number of Full Time Employees:

Number of Part Time Employees:

Annual Membership Investment

Total: $

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Full-Time Employees
Part-Time Employees
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories

Annual Dues (charged to card)

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Payment Type *

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

Credit Card Type * MastercardVisaDiscoverAmex

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

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Please enter number of employees before submitting your application.

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Join Us - Greater Lehigh Valley Chamber of Commerce