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About the Chamber

Membership Application

Company Name
Primary Contact
First Name
Last Name
Title
Physical Address
Address 1
Address 2
City
State	AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY AB BC MB NB NL NS NT NU ON PE QC SK YT Outside US
Zip+4
County
Country
Email
Web Site
Daytime Phone + Extension
Fax
Billing Address (if different from physical location)
Address 1
Address 2
City
State	AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY AB BC MB NB NL NS NT NU ON PE QC SK YT Outside US
Zip+4
How did you hear about the Frederick Chamber?
What is your main reason for joining the Frederick Chamber?
Number of employees within 45-mile radius of Frederick County
Full Time
Part Time
Referred by (name, company)
Type of Business	.............................. For Profit Non-Profit Government Agency Other
Billing Cycle	.............................. Quarterly Semi-Annual Annual
Membership Investment Levels (Based on your number of Full-time Employees)	.............................. 1 ($350) 2-5 ($400) 6-10 ($500) 11-15 ($650) 16-20 ($750) 21-30 ($950) 31-50 ($1100) 51-70 ($1350) 71-100 ($1500) 101-250 ($2250) 251-500 ($3250) 501-1000 ($3500) 1001+ ($4000)
One-time Administration Fee: $ 30.00
Please charge my: MastercardVisaAmex
Credit Card Number                  Name On Card Security Code (3-digit code on back of card) Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Use Address Above Credit Card Address 1 Credit Card Address 2 Credit Card City Credit Card State AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY AB BC MB NB NL NS NT NU ON PE QC SK YT Outside US Credit Card Zip Credit Card ZipExt Credit Card Phone Number Credit Card Country
Please click submit only one time.  The transaction may take several seconds.

Once your membership is approved, we'll send your login information so you may add employee representatives and set communication preferences. You'll also be able to create your directory listing, including a company description, category, and keywords.