Business Membership Application
Business Name:
Address:
City:
State:
Zip:
Mailing Address:
Telephone:
Fax:
Email:
Contact Person First Name:
Last Name:
Contact Person Title:
Years Business Based in Riverside Area:
Type of Business:
Wholesale
Retail
Manufacturing
Service
Other
If Other, please describe:
Principal Product or Service:
List Two Other Persons to be Voting Members:
Name:
Title:
Name:
Title:
Briefly describe your interest in becoming a member of the Riverside Area Chamber of Commerce:
Would you be willing to serve on a committee?
Yes
No
Membership dues are $155.00 per year. Dues are payable June 1 each year. New members prorated at $13.00 per month. Make checks payable to Riverside Area Chamber of Commerce and mail to PO Box 9074, Riverside, MO 64168.
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