Membership App Landing Page

Membership Application

Membership Type *

Individual Membership ($50)

Small Business Membership ($75)

Large Business Membership ($125)

School or University Membership ($250)

Business Name *

School or University Name *

Your Name *

Email Address *

Street Address *

City *

State *

Zip Code *

Phone Number *

Cell Phone Number

Opt in for Text Notifications? *

Yes

CEO or Managers Name *

Additional Contact Name

Billing Address (If Different Than Street Address)

Business Description *

Number of Employees *

Payment Type *

By Mail

Online using your Debit / Credit Card, Venmo , Apple Pay, or PayPal

Payment Address

Mail Payment to:

Lewis County Chamber of Commerce
141 2nd St
Vanceburg, KY 41179

First Name

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