Vermont's Northeast Kingdom Chamber of Commerce

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Please fill out the following membership application and profile data form (see above), and it will be e-mailed to the chamber immediately. As the chamber cannot yet accept credit card payments on line, please call 802-748-3678 with your credit-card information or make out a check for the required amount and send to:

Northeast Kingdom Chamber

51 Depot Square-Ste. 3

St. Johnsbury, VT 05819

Please note that we cannot process your membership until we receive payment. You do not have to send this membership application in the mail, but please make your business name and contact information clear on the check.

Join the Chamber after June 30th of each year and pay 1/2 of the posted annual Membership Dues. Full year Membership Dues will be billed January of each year.

2010 NORTHEAST KINGDOM CHAMBER APPLICATION

COMPANY INFORMATION

BUSINESS NAME:

NAME / TITLE:

PHYSICAL ADDRESS (INCLUDE TOWN,STATE,ZIP):

MAILING ADDRESS (INCLUDE TOWN,STATE,ZIP):

COMPANY PHONE:

DESCRIPTION OF BUSINESS:

*E-MAIL ADDRESS:

WEB SITE:

MEMBER CLASSIFICATION:

General Business Professional

Banks Not-For-Profit

Individual Travel

GENERAL BUSINESS Number of employees includes owners & officers who work on premises.
(2 part-time employees = 1 full time employee.)

BANKS: (Based on Deposits)

INDIVIDUAL : (not in business)

$ 68.00

NOT-FOR-PROFIT ORGANIZATIONS

$ 188.00
# of employees

plus $ 1.00 for each employee

PROFESSIONAL FIRMS

Accountants Architects Attorneys Chiropractors Dentists
Doctors

Optometrists
Surgeons
Ophthalmologist Psychologists Psychotherapists
Funeral Directors

Stock Brokers
Insurance Agents Marketing Agents
Real Estate Brokers
Engineers
etc.

$ 264.00 for firm & first principal
# of additionals

plus $76.00 for each additional principal,agent, or associate.

TRAVEL: Lodging

$ 234.00 plus

units

For first 40 units

$ 5.50 per unit

Each unit over 40

$ 3.15 per unit

TRAVEL: Lodging & Dining

$ 234.00 plus

units

For first 40 units

$ 6.60 per unit

Each unit over 40

$ 5.25 per unit

TRAVEL: Restaurants

$ 234.00 plus

units

For first 100 seats

$ 2.75 per seat

Each seat over 100

$ 1.30 per seat

Who referred you?

Primary reason for joining

When you hit submit application, this form will be e-mailed to the chamber.

We will be awaiting the receipt of your payment.

Northeast Kingdom Chamber ~ 51 Depot Square, Suite 3 ~ St. Johnsbury, VT 05819
Web: www.nekchamber.com ~ Email: nekinfo@nekchamber.com ~ (802) 748-3678 ~ 1-800-639-6379

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