Member - Broomfield Chamber of Commerce

Business Information

Company Name: *

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Phone: *

Website:

Email: *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

How did you hear about the Chamber?: *

My services are best described as:

Expectations: *

What are you hoping to gain access to through membership? :

Are you interested in sponsorship opportunities? :

What is your biggest goal? :

What opportunity or program are you most excited to be a part of as a Broomfield Chamber member? :

What is your industry? :

Briefly describe your best or current clients:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Twitter Youtube Pinterest Google+ Blogger Instagram

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

1-9 Full Time Employees : $345.00
This option is for businesses with 1-9 full time employees. 2pt=1ft 10-25 Full Time Employees: $400.00
This option is for businesses with 10-25 full time employees. 2pt=1ft 26-59 Full Time Employees: $600.00
This option is for businesses with 26-59 full time employees. 60-99 Full Time Employees: $800.00
This option is for businesses with 60-99 full time employees. 100-299 Full Time Employees: $1,200.00
This option is for businesses with 99-299 full time employees. 300-499 Full Time Employees: $1,800.00
This option is for businesses with 300-499 full time employees. 500+ Full Time Employees: $3,400.00
This option is for businesses with 500+ full time employees.

Additional Fees:

One-time administration fee : $35.00
A one-time $35 administration fee

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address