Application Form for 2012

 

Name:__________________________

Address:________________________

City:_____________ State:________

 Zip:__________

Business Phone:______________

Home Phone:_________________

Fax:________________________

E-mail:_____________________

WEB Address:____________________

Type of Business:________________________

Please check

Basic Membership:($50/year)_____________

Seasonal Membership:($15)_____________
(Farmers' Market)

Banner Link:(additional $50/year )________  

Web page with Chamber: ($150)________
(www.lyonschamber.org/yourname

Medical Insurance:____________

Interested in Chamber Board of Directors:________

Please make Check payable to: Lyons Chamber of Commerce