* denotes required field

*Name:


*Company:


Street Address:


*City:

State:   Zip:


*Phone:                                 Fax:
  

E-mail Address:

 

Person who Referred You to the Chamber (if applicable):

Please Place an X in the appropriate Box

Number of Full-Time Employees

 

1-5 ($350)

6-10 ($450)

11-15 ($550)

16-20 ($650)

21-25 ($750)

PAYMENT*

VISA:


MC:


AmEx:


Card Number:
Please Call me for my Credit Card Number and Expiration Date!

 

I am Mailing a Check:

 

Click Here to Download Membership Application

 

Make checks payable to North Shore Chamber of Commerce, Inc.

 

Mail Check to:

Membership Drive

North Shore Chamber of Commerce

5 Cherry Hill Drive

Suite 100

Danvers, MA 01923

 

Or Fax Membership Application to (978) 774-3418, Attn: Stephen Crowder

Comments:

© 2006 North Shore Chamber of Commerce. All rights reserved.