Membership Application

Please complete the following application and submit to the Chamber of Commerce. Once received, a Chamber representative will contact you promptly. You must pay dues at the Business Membership Level to list your membership in the name of your business. * denotes a mandatory field.

Online Membership Application

Name Of Business: *
Type of Business: *
Primary Contact *
Title
Address of Business: *
Primary Phone Number: *
Secondary Phone Number:
Fax Number:
Primary Contact Email: *
Company Website Address:
Total Number of Employees *
Method of Payment *
Do you wish to offer any type of discount to other chamber members? * Yes

No

Please describe your offer
Please tell us why you wish to join the Liberty County Chamber of Commerce *
Liberty County Chamber of Commerce
912.368.4445		US Chamber of Commerce