Greater Medina Area Chamber of Commerce

MEMBERSHIP APPLICATION

To join the Greater Medina Chamber of Commerce, please complete the information below. if you have questions please contact the Chamber office at 330-723-8773 or info@medinaohchamber.com.

Click here for 2009 Dues Schedule

Thank you for your interest in the Greater Medina Chamber.

*Company:

*Address:

*City:

*State:

*Zip Code:

*Phone:

Fax:

Email:

Web Site:

*Number of Employees :

*Classification:	Medina County Business Out of Medina County Business Non-Profit Organizations Associate Members Public Utilities, Financial Institutions, Hospital


Click here for the Investment Schedule by Classification.
*Primary Representative:

Other Representatives - include email addresses:

*Credit Card Type:	Visa Mastercard

*Credit Card Number:

*Credit Card Code:

*Credit Card Expiration:

*Name as it appears on card:

*Address as it appears on card:

*Zip Code as it appears on card:

*Category:

Reason for Joining:

*Brief Description of Company (up to200 characters):

Sponsor's Name:

*Amount to be Charged (Investment plus $25 proc fee:

Feedback / Message:

Your e-mail address will be used for Chamber correspondence only. We do not publish, sell or distribute e-mail and/or fax information.