Online Membership Application

Name or Business Name*
Address:*
Phone:*
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Fax:
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E-mail:*
Website:
Business Type:*
Number of Full Time Employees:*
Number of Part Time Employees:*
Year Established:*
Owner or Managers Name:*
Owner or Managers Title:*
Owner or Managers Phone:*
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Owner or Managers Fax:
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Owner or Managers E-mail:*
How did you hear about the Chamber?*
What do you hope to gain as a member of Lewis County Chamber of Commerce?*

Rates:

Individuals and Small Businesses - $50

Professionals (Doctors, Lawyers, etc.) - $100

School Boards - $200

Please make checks payable to Lewis County Chamber of Commerce and mail to:

Lewis County Chamber of Commerce
PO Box 472
Vanceburg, KY  41179

By submitting this form, I agree to the terms and conditions of the Lewis County (KY) Chamber of Commerce.