CANYONVILLE AREA CHAMBER OF COMMERCE
P.O. BOX 1028
CANYONVILLE, OR 97417
www.canyonvillechamber.org
MEMBERSHIP APPLICATION FOR 2010
Membership Year is January 1, 2010 – December 31, 2010

Please complete the following information (*) and return with your payment:

Business Name______________________________________________

Person representing the Business______________________________

Or Individual Name if joining as and individual:
___________________________________________________________

Address_____________________________________________________

Mailing Address_______________________________________________

Phone Number________________________Fax Number_______________

Email address__________________________________________________

*The above information is essential for better communications and will help us promote your business.

Annual Membership Dues:
_____Private Individual - $30.00 $__________

_____Business - $50.00 $__________

_____Link your business or personal web site to the Chamber’s
Web-site - $50.00 $__________
Total Due $__________
Payment Options:

____Payment enclosed Check#______Date:____________
Cash Received (amount):____________Date:____________

Note: To include your business as a 2010 Chamber member on brochures, mailings and
Other promotional materials, full payment must be received by February 28th. Otherwise, full payment must be received by March 31, 2010 to continue to receive all other benefits of membership. New members are welcome to join anytime.
Have Questions? Contact Jake Young, Pres. at 839-4125 or Pam Young, Sec.at 839-4291.