Application for Membership:

To: Greater Crawford Chamber of Commerce & Agriculture

I/We want to become a member of the Greater Crawford Chamber

of Commerce and Agriculture.

Date: ___/___/___

Name of Business or Individual: _______________________________

Name of Contact Person: _____________________________________

Names of other Active Members of your firm:

____________________________________________________________

____________________________________________________________

____________________________________________________________

We select the following level of membership:

_____ Voting Membership

_____ Participating Membership (non-voting)

_____ Honorary Membership

I am interested in serving the following area:

_____ Economic Development

_____ Community Development

_____ Human Resources

_____ Public Affairs

Address: ____________________________________________________

____________________________________________________________

____________________________________________________________

Telephone: ________________________________________________

Fox: _____________________________________________________

E-Mail: _____________________________________________________

Web Site: __________________________________________________

Signature: __________________________________________________