Join Us - Greater Lehigh Valley Chamber of Commerce

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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:

Fax:

Website:

Additional Contacts

Additional Information

Facebook Page URL:

Twitter URL:

Referred By:

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.

Please list all of your interests

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

Chamber Member Required Please enter a valid number Please enter a valid date	Website
Newspaper	Television
Radio	Attended an Event
Billboard	Broker
Blue Cross	Other Required Please enter a valid number Please enter a valid date

Membership Investment

Membership Type: *

Number of Full Time Employees:

Number of Part Time Employees:

Primary Business Category (included) *

Additional Directory Category ($100 each)

Annual Membership Investment

One-time Application Fee

$30

Total: $

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

Annual Dues (charged to card)
Fee (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 *

Mastercard

Visa

Discover

Amex

Credit Card Number

Name On Card	Required
Security Code	Required
Valid Through
	Use Address Above
Credit Card Address 1	Required
Credit Card City	Required
Credit Card State
Credit Card Zip	Required
Credit Card Phone Number	Required
Credit Card Email Address

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Thank you to our 2024 Directory Sponsors and our Corporate Partners

Join Us - Greater Lehigh Valley Chamber of Commerce