Member

Please fill out the application to join the Irish Hills Regional Chamber of Commerce. If you have questions about your membership dues, please contact the President/CEO at 592-8907 or cindy@irishhills.com.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees:

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook YouTube Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone:

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook YouTube Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone:

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook YouTube Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Print Application

Member Application

Mailing Address

Address

Address