Membership Application

Please complete the form below to join the Kearney Chamber of Commerce.

Details

Company/Individual Name

Phone

Company Website

Company Email

Preferred Method of Communication

Year Business Established

Full Time Employees

(Closest #)

Part Time Employees (Closest #)

Referred By

Addresses

Mailing Address

Enter Below

Physical Address

Business Categories

Online/Print Directory Info

Display in Online Directory
(Must be approved by Chamber)

Business Info
Display Name
Phone
Fax
Online Directory Listing Address
	,


Note Displayed on Initial Website Search (250 characters)
Short Description for Website
Business Logo	Temporarily Disabled - Email your logo directly to the Chamber.
Website
Website 2
Email
Facebook
Twitter
YouTube
Instagram

Primary Representative

Billing Representative

Primary Rep is Billing Rep
Uncheck if your organization has different primary and billing reps

Membership Dues
Select Membership Level	Annual Membership: 5 or less employees Annual Membership: 6 to 10 Employees Annual Membership: 11 to 20 Employees Annual Membership: 21 to 30 Employees Annual Membership: 31 to 50 Employees Annual Membership: 51 to 75 Employees Annual Membership: 76 to 100 Employees Annual Membership: 101+ Employees Annual Membership: Business Associate Individual licensed to a member business, i.e. Real Estate Agent, Hair Dresser, etc. Annual Membership: Individuals (Non-Business) Not Retired, Not Selling, Not Associated with a Business Annual Membership: Individuals - Retired (Over 55 - Non-Business)

Membership Dues

Select Membership Level

Please select your membership type above and continue to the credit card payment form.