Membership Application

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For the purpose of promoting the commercial, industrial, educational and civic interest of the Jefferson City area, the undersigned subscribes for membership. The primary term of this contract shall be for one year and shall be continued for consecutive terms of one year or until terminated in accordance with the Bylaws.

Business or Organization : 
Type : 
Main Contact : 
Title : 
Please select one : 
 Mr.  Mrs.  Ms.  Miss  Dr.
Business Address : 
Billing Address (if applicable) : 
Phone : 
Fax : 
Business Info E-mail : 
Main Individual E-mail : 
Web : 
Business Category : 
# of Employees : 
Full-Time : 
Part-Time : 
Date Estab (MM/DD/YY) : 
Business Description for on-line directory : 
Key Words for on-line directory search : 
Membership Type : 

* Each organization is allowed one member for the base rate, plus one member for each additional $100 paid.

* An additional $20 fee for new members will be charged for administration expenses. This fee does not apply to second and subsequent year members

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