Membership Application
For Internal Use
Email:_______
CC: _________
QB: ________
Belhaven Community Chamber and Welcome Center
265 E. Water Street, Suite 101 P.O Box 147, Belhaven NC 27
252-943-3770 belhaveninfo@rsnet.org
Please Print -
Date:
Business Name/ Personal Name
Primary Contact Name
Title
Additional Contact Name
Title
Physical Address including city, state and zip (This will appear on our website)
Mailing Address including city, state and zip
Billing Address (if different) including city, state and zip
Business Phone
Cell Phone
Other Phone
Website
Description of business Please give a brief description of your business. This will appear on our website
Check
Please choose desired membership level from the attached options.
-MEMBERSHIP LEVEL
See enclosure for Membership Levels and Investment
INVESTMENT
Individual Membership (see enclosure for amount)
Business Membership
We would consider sponsoring a Chamber event
We would like more information on hosting a Chamber Business After Hours event.
Membership level Total: $________________
Method of Payment:
Check Enclosed
Credit Card Number and Name on Card
Expiration Date:
V-Code
Credit Card Address (if different)
City
Billing Zip Code
Member Signature: ___________________________________ Date: ______________
Would you like to auto renew your membership annually? ______________________