Membership Investment (+ Application Fee Add $25):

Total Investment:

Firm:

Address: (Required)

City: (Required)

State: (Required) NoneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP: (Required)

Primary Contact:

First Name: (Required)

MI:

Last Name: (Required)

Title:

Categorical Listing for Membership Directory:

Phone:	Contact Preference: No Preference Phone Email
E-mail: (Required)

Web Site:

Name Confirmation:

Beginning Date:

The confirmed name above subscribes the total investment annually to the Wheeling Area Chamber of Commerce beginning at the above date. Payable in advance, and in consideration of this subscription being approved, agrees to pay the above stated sum each year until written resignation has been presented to the Board of Directors.