LVChamber: Membership Application

Membership Application

Complete the form below to submit your membership information to the Lebanon Valley Chamber. Upon
review and approval of your application you will be sent a confirmation email with your membership
information and payment options.

Business/Organization Information:

Business/Organization Name:

Type of Business/Organization:

Primary Representative's Name:

Primary Representative's Title:

Primary Representative's Email Address:

Street Address/P.O. Box:

City/State/Zipcode:

Phone/Fax:

Website Address:

Billing & Voting Contact Information:

Billing Representative:

Billing Representative's Email Address:

Street Address/P.O. Box:

Same as above

City/State/Zipcode:

Voting Representative:

Voting Representative's Email Address:

Additional Information:

Add. Representative 1:

Add. Representative 1 Email Address:

Add. Representative 2:

Add. Representative 2 Email Address:

How did you hear about the Lebanon County Chamber?

Reasons you decided to join the Lebanon County Chamber?

Who can we thank for your decision to join the Chamber

* Employee count must be completed for our records and accurate membership investment calculations.

Two part-time employees = One full-time employee for annual membership benefit rates. Please see annual
membership investment schedule for more information.

* All membership applications are subject to approval by the Chamber's Board of Directors.

Permission is given for the Lebanon Valley Chamber to send unsolicited email and fax
communications to the addresses provided above.

Membership investments in the Lebanon Valley Chamber of Commerce are not tax deductible as
a charitable contribution, put a portion is deductible as a business expense. As the Chamber
engages in lobbying, under federal law (5) percent of investments for 2011 are
non-deductible; 95 percent are deductible.