Membership Application

Company Name:

Main Contact:

Title:

Business Address:

City:

State

Zip:

Phone:

Fax:

Email:

Website:

Date Established:

Reason for joining:

I will accept electronic communications from Chamber:
Yes No

# full time employees:

# of seats, units or rooms (for Hotels & Restaurants only):

Business Category:

Referred by:

Please give a brief (one or two sentences) description of your business:

Industry specific Keywords:

Names:

Titles:

Phone:

Email:

15100 W. 67th Street, Suite 202
Shawnee, KS 66217-9344