*Required Fields

*Business Name:

CONTACT INFO:
*First Name:
*Last Name:
*Cell:
*E-Mail:

New Member - Complete All Sections
Renewal - See Changes Below
Renewal - No Business Info Changes Needed

BUSINESS INFO
(You may skip this section if the business information at pennyorkvalley.com is correct)

Address:
City:
State:
Zip:
Phone:
Fax:
E-Mail:
Website:
Number of Full-Time Employees:
BUSINESS CATAGORY
(You may view our present catagory options in the dropdown under the logo in the header)

MISC

1) How do you prefer correspondence? Email Mail
2) Would you like to schedule a chamber mixer at your business? yes no Date
3) Are you interested in being a Board of Director? yes no
4) Do you wish to accept Valley Gift Certificates? yes no
5) Are you interested in offering a Member 2 Member Discount? yes no
. . Your discount will be:
6) For new/relocated businesses, when would you want to hold your ribbon cutting?

Payment Method:
After submiting this form, I will pay the above total via
my Paypal account
as Paypal Guest using my Credit Card
a check mailed to GREATER VALLEY CHAMBER OF COMMERCE 109 Chemung St., Waverly, NY 14892

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