Member - Poplar Bluff Area Chamber of Commerce

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords (enter a space between words)

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax *

Please add your fax number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Facebook

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax *

Please add your fax number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Create Account

Password *

Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

Financial Insitution

Banks, Credit Unions, etc.

Real Estate

Any Real Estate Agency that is looking to join OR agent of a real estate agency. See fee schedule and enter fee here:

Please enter your fee.

Retired Persons $ 125

An Individual who still would like to support the community by being a member and is retired.

Non-Profit $ 275

Must be a non profit organization.

Other

Retail, Service, Manufacturing Business, Professionals (Atty., CPAs, Dentists, Chiropractors, Optometrists, etc.) See fee schedule and enter fee here:

Please enter your fee.

Comments/Questions

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

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MicroNet Template

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Social Network Addresses

Create Account

Step 5:

Membership Package

Payment Option