<p> Covington-Tipton County Chamber of Commerce Membership Application</p><p>Date:______</p><p>Company Name:______</p><p>Street Address:______</p><p>Mailing Address:______City:______State:______Zip Code:______</p><p>E-mail:______</p><p>Website:______</p><p>Phone:______Fax:______</p><p>Business Owner:______Contact Person 1:______</p><p>Billing Representative:______Contact Person 2:______</p><p>Briefly describe business, if you are a retail business, please list what sets your company apart:______</p><p>______</p><p>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.</p><p>Name:______E-mail:______</p><p>Name:______E-mail:______</p><p>Name:______E-mail:______</p><p>Name:______E-mail:______</p><p>Do you wish to receive blast faxes?______YES______NO</p><p>Do you wish to receive blast e-mails______YES______NO</p><p>Do you wish to be added the the Chamber Gift Certificate known as “Chamber Bucks”? ______YES______NO</p>