MEMBERSHIP APPLICATION & SURVEY FORM

( ) NEW - ( ) RETURNING MEMBER

$25.00 Individuals, $36 for Business - Payable to Weaverville Chamber of Commerce

Weaverville Chamber of Commerce

P.O. Box 345

Weaverville, CA 96093-0345

Member Name (First, MI, Last)_____________________________________

Mailing Address:_________________________________________________

City: ______________________ State _______ ZIP ____________________

Phone(Home): (____) _____-________ Phone(Work): (____) _____-_______

E-mail: ________________________________________________________

Business Name __________________________________________________

Website:________________________________________________________

Address:________________________________________________________

City: ______________________ State _______ ZIP _____________________

Phone(Work): (____) _____-________ FAX Phone: (____) ______- _______


 
() Help with Newsletter Production () Help with Website
() Work on Brochure/Packet Project () Man Information Booth at Public Events
() Help with bookeeping  () Represent W CofC at NorthState Meetings
() Help with meeting programs () Help prepare food for WCofC functions
() Help with Community Grants () Help with Membership Drive"
() Help with Emergency Preparedness Projects () I would like to______________________
() Help with secretarial work () Drive others to WCofC meetings
() I would like to know more about WCofC () I would like to work on Relocation Packet Project
() I would like to help make signs () I can display WCofC information signs in my business