Join the Chamber

Online Membership Application

Company Information
Company:
*
Address Line 1:
Address Line 2:
City:
*
State:
*
Zip:
*
Phone 1:
*
Phone 2:
Fax:
E-mail:
*
Website:
Bus. Category 1:
Bus. Category 2:
Full-time Employees:
Part-time Employees:
Business Description (40 words or less)
Members-only Account Login
Members-only allows you to update your information online via a secure login.
Admin E-mail:
*
Password:
*
Verify Password:
*
Contacts
Primary Contact
Prefix:
First Name:
*
Last Name:
*
Suffix:
Familiar Name:
Title:
 
Billing Contact
 
Annual Membership Dues
Employees
Amount
1-2
210.00
3-5
300.00
6-10
410.00
11-25
525.00
26-50
655.00
51-100
925.00
100+
1,065.00
$210.00
$430.00
$165.00
$110.00
$100.00
Application Fee:
$25.00
Total:
$0.00
Applicant agrees to pay annual membership dues of $0 to the Lafayette Chamber of Commerce. Annual dues are based on number of full time employees (see rates above). Membership will be continuous until cancelled by the member or terminated by the Chamber. Membership renewal is billed annually in the month the membership began. To terminate your membership, a 30 day notice is required!
Security Code:
Please enter the security code above.
  
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