Covington-Tipton County Chamber of Commerce Membership Application

Date:______

Company Name:______

Street Address:______

Mailing Address:______City:______State:______Zip Code:______

E-mail:______

Website:______

Phone:______Fax:______

Business Owner:______Contact Person 1:______

Billing Representative:______Contact Person 2:______

Briefly describe business, if you are a retail business, please list what sets your company apart:______

______

We provide blast e-mail service for all of our members. If you wish to receive emails updating you on the latest Chamber activities and member information, please list ALL e-mail addresses of employees who wish to receive this service.

Name:______E-mail:______

Name:______E-mail:______

Name:______E-mail:______

Name:______E-mail:______

Do you wish to receive blast faxes?______YES______NO

Do you wish to receive blast e-mails______YES______NO

Do you wish to be added the the Chamber Gift Certificate known as “Chamber Bucks”? ______YES______NO