Hornell Area Chamber of Commerce 
Application for Membership

Choose one of the following types of memberships:

Non-Profit Organizations  $60.00		6-15 Employees   $220.00
Individual/Sole Proprietor  $135.00		16-25 Employees   $350.00
2-5 Employees   $200.00		50-100 Employees   $550.00
Corporation (300+ employees)  $1000.00

Please enter Member information below.  (Use TAB key to change field.)

Business Name 
Contact Name      Title
Address
City   State   Zip
Business Category     Phone
Email    Fax

Web Page

I understand memberships are non-refundable and non-transferable.

I understand that if I am unable to pay the full fee at this time, I can make payments according to the Chamber payment plan.

Date              Signature

Fax To:  (607) 324-3776

Please also print this form and sign it - it's FAX friendly!!