Online Application for Chamber Membership :: Pleasant Hill Chamber of Commerce

Chairman's Circle
PG&E

Online Membership Application

Please fill out the application below completely, being sure to complete all required portions (indicated by an * ). If you have not already done so, please review our membership dues table, and if you have any questions, please contact the Chamber at (925) 687-0700 or via Email.

Part 1: Your Business Information

Company Name

Number of Employees

Full Time:	*
Part Time:	*

DBA

Business Email

Key Contact

Name of person to receive communication, updates & invoices from Chamber.

*
(Please enter the key contact's full name)

Physical Address

Street:	*
City:	*
Zip:	*

Billing Address

If different from Physical Address

Street:
City:
Zip:

Phone

Fax

Business Website Address

Please provide homepage address (ending in .com, .org, etc.)

Business Description (230 Character Limit)

characters remaining

	Please upgrade my online directory listing to the Premium Level to increase my exposure on the Chamber website (more info »)
	Also create a one-page Member Profile website for me since my business does not have its own website (more info »)

Part 3: Additional Mailings

Who else in your company should receive chamber mailings?

Name
Mailing Address (if different)
Email

Part 4: Why Are You Joining the Chamber?

Please check which Chamber benefits are most important to your business.

Business Assistance and Advice

Professional Development/Training (seminars)

Marketing/Advertising Opportunities

Networking/Generating New Business

Directory Listings/Phone Referrals

"Business News" Newsletter

Member Discounts

Business Advocacy

Community Involvement and Support

Other

Part 5: How were you referred?

Please check all that apply:

	Information Obtained From This Website
	Attended a Recent Chamber Event
	Referred by a Chamber Ambassador or Board Member
	Ambassador/Board Member's Name
	Referred by a Friend or Colleague
	Friend/Colleague's Name

Part 6: Miscellaneous

	Please do not add my company's name to mailing labels or lists sold by the Chamber
	Please do not list my company on your website membership directory

Webmaster is Les Bain at Wizard Creek Consulting
Send comments and corrections to webmaster@pleasanthillchamber.com