Member Application Thank you for your interest in Jefferson County Chamber of Commerce! Step 1: Member Info Step 2: Additional Info Step 3: Primary Contact Step 4: Billing Contact Step 5: Membership Options Step 1: Member Info Company Name * Please add your company name. Leave Blank Phone * Please add your company phone number. Website Email * Please add a valid email. Physical Address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Mailing Address Same as physical address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Step 2: Additional Info Business Description (200 char max) Business Keywords (enter a space between words) Directory Category Choose... Ag Financing Agriculture Air Conditioning / Heating Arts Auction Bank Bed & Breakfast Behavorial Health Blood Donation Board of Education Bookstore Bookstore Business & Professional Services Buy & Sell Timber Cargo Transport Church Church / Worship Church/Worship City Community Theatre Competitive Cheer & Tumbling Computer Services Convenience Store Dentist Dining Education education/school/private school Electric Coop Electricity Elementary School Engineering Services Event Location Farming Financial & Insurance Products Financial Services Fitness, Exercise, Sports Flower Shop Flowers / Gifts Funeral Services Furniture Garden Club Gas Station Gasoline & Diesel Hardware, Lawn, Garden Healthcare High School History Hospital / Clinics / Emergency Room Individual Industry Insurance Insurance / Employee Benefits Internet, Cable, Phone Job Placement Kaolin Mining Landscaping Law Practice Lending Institution Library Loans Local Art Lumber Products Machining / Sprockets / Fabrication Manufacturing Sawmill Equipment Medical Billing Mining Monogramming Municipality Non-Profit Nursing Home / Long Tem Care / Short Term Rehabilitation Office Furniture Office Supplies Outpatient Clinic Peanut Buying Point Pest Control pharmacy/gift shop Photography Services Political Publishing Radio Stateion Real Estate Real Estate Broakerage Rental Properties Restaurant Retail Retail Gifts Roofing Sawmill Equipment Screenprinting, Promotional Products Shopping Center Short Term Overnight Accomodation Speaker Development Training Tax Preparation / Bookkeeping Technical College tools, industrial supplies Trucking Truckwashing & Maintenance Facility Utilities Zimmatic Irrigation, Brock Grain Bins, Butler Steel Buildings Full-time Employees * Please add your number of full-time employees. Part-time Employees * Please add your number of part-time employees. Step 3: Primary Contact First Name * Please add your first name. Last Name * Please add your last name. Title Phone * Please add your phone number. Cell Phone Fax Email * Please add a valid email. Contact Preference Email Phone Address Same as Address in Step 1 Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Create Account This Login is already in use Login Password Step 4: Billing Contact Same as Primary Contact First Name * Please add your first name. Last Name * Please add your last name. Title Phone * Please add your phone number. Cell Phone Fax Email * Please add a valid email. Contact Preference Email Phone Address Same as Primary Contact Address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, FYRO Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Venezuela Vietnam World Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Create Account This Login is already in use Login Password Step 5: Membership Package Please select a Membership Package Banks $ 475 Utilities $ 350 Comments/Questions Payment Option Bill Me Charge my credit or debit card Please complete the Captcha Back Next Submit Application Print Application