Member Application

Thank you for partnering with the Marksville Chamber of Commerce. We look forward to working with you to grow our business community.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category:

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Business Membership: $80.00
1-30 employees brick and mortar Corporate Membership: $130.00
31 or more employees Associate Membership: $40.00
Single Members (do not own business) Associate Couple Membership: $75.00
Couple Membership (do not own business) Up and Coming: $40.00
Self employed, no brick and mortar, online business Non Profit: $10.00

Payment Option:

Charge my credit or debit card

Print Application