MEMBERSHIP APPLICATION

Please complete this Membership Application to become a member of the Blackstone Valley Chamber of Commerce. Please note that base membership dues investment is $295 for companies with five or fewer employees. For additional employees, please add $5 each. Please call the Chamber at 508.234.9090 to pay your membership fees.

Fields in red are required.

Date:
First Name:
Last Name:
Title:
Company:
Mailing Address:
City:	State:
Zip:
Email:
Telephone:
Fax:
Website:
Type of Business:
Number of Employees:
Year Established:
Sponsored by:
	Please enter the keycode below in the keycode field.
Key Code:	QT54J2
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