CHAMBER MEMBERSHIP APPLICATION Membership Investment Amount is based on the number of employees working in the Williston area. If joining after April 1st, the Membership Investment Amount will be prorated. The Williston Area Chamber of Commerce is a 501(c)6 non-profit organization. Members’ investment in the Williston Area Chamber of Commerce may be tax deductible as an ordinary and necessary business expense, but not as a charitable tax deduction for federal tax purposes. q CHILDCARE? CONTACT US q 11-20 EMPLOYEES $500/year q INDIVIDUAL MEMBERSHIP q 21-35 EMPLOYEES $610/year NOT VALID FOR BUSINESSES $110/year q 36-50 EMPLOYEES $830/year *If you are signing up a business with only 1 employee, select the ‘1-10 Employees’ listing. q 51-99 EMPLOYEES $1,650/year q GOVERNMENT/NON-PROFIT MEMBERSHIP $220/year q 100+ EMPLOYEES $2,200/year q 1-10 EMPLOYEES $360/year Business Name __________________________________________________________________________________________________ Street Address __________________________________________________________________________________________________ Mailing Address __________________________________________________________________________________________________ City State Zip Code __________________________________________________________________________________________________ Phone # FAX 800# __________________________________________________________________________________________________ Email Address Website __________________________________________________________________________________________________ Primary Representative & Job Title __________________________________________________________________________________________________ Email Phone # __________________________________________________________________________________________________ Billing Representative & Job Title __________________________________________________________________________________________________ Email Phone # __________________________________________________________________________________________________ # of Local Employees Company Start Date: __________________________________________________________________________________________________ Social Medial pages __________________________________________________________________________________________________ Please describe your business in 30 words or less Signature Date __________________________________________________________________________________________________ Please attach additional representatives you would like listed with your company on an additional sheet if needed.