NEW
KENSINGTON AREA CHAMBER OF
COMMERCE
MEMBERSHIP APPLICATION
MEMBER BUSINESS
Business Name: ______________________________________________________________________
Or Individual Name: _________________________________________________________________
Address:
City: State:_______ Zip:
Phone:______________________ Fax:______________________
Email:
In Business since:
______________________________ Number of Employees:
Website:
Brief description of
business:
Annual Dues:
PRIMARY CONTACT
Full Name:
Business Title:
First Name Preference: Birth Date (Month, Day):
Phone: _________________________ Fax: ______________________
Email:
OTHER CONTACTS
CHAMBER PARTICIPATION
q I would like to be active in the Chamber (see attached list of committees)
q I would like to sponsor an ad in the newsletter Chamber Chat
q I would like to receive information on health care coverage through the Chamber.
Suggestions:
Please print, fill out application, and Fax to 724-339-3346
Please make your check payable to:
New Kensington Area Chamber of Commerce
858 Fourth Avenue
New Kensington, PA 15068
Phone: 724-339-6616