Member Application

Welcome to the Chamber. If you have 50 or more employees or are a 501(c) organization, please contact the Membership Department at 608.443.1944

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email:

Business Description (1000 char max):

Directory Category:

Employees:

Full-time Part-time

Comments / Questions:

Date Established: Select M/d/yyyy

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter Instagram YouTube

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Small Business, 1-5 Employees: See fee schedule to determine the fee and enter it below.
Small Business 6-25 Employees: See fee schedule to determine the fee and enter it below.
If using fee schedule, enter fee here:

Payment Option:

Bill me Charge my credit or debit card

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