Member Application

Joining our Chamber of Commerce is easy. Just follow the steps and complete the form below to become a member of the Lakewood Chamber of Commerce.

Business Information

Company Name: *

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 Twitter YouTube Instagram

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 Twitter YouTube Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

1-5 Employees: $160.00
6-15 Employees: $215.00
16-25 Employees: $275.00
26-50 Employees: $340.00
51+ Employees: $510.00
Freight Forward: $450.00
Non-Profit: $140.00

Additional Fees:

One time initiation & setup fee : $35.00
A one-time initiation fee of $35.00 is required at the time you pay your first year's Chamber of Commerce Dues.

Payment Option:

Charge my credit or debit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 9 plus 2?: *