Amherst County Chamber of Commerce
2013 Membership Application
Print and mail this form along with check to:
Amherst County Chamber of Commerce (ACCC)
PO Box 560
Amherst VA 24521
Join us with an eager and creative spirit dedicated to improving the commerce industry in our county. We stand ready to hear the issues that concern you as a business person in Amherst County. Don't be left behind! Your business is our business!
In order to give the organization a steady and dependable income on which to plan its community development programs, it is hereby agreed this membership is to be continuous unless cancelled in writing. All members are invoiced during the months of December/January to coincide with the Chamber's fiscal year. For brand new members, the 4th quarter of 2012 is FREE if you pay 2013 dues at the time of joining.
The undersigned hereby applies for new membership based on the number of employees (_____) and agrees to pay the Amherst County Chamber of Commerce $________ for January through December 2013 membership. After March 31st, call 434-946-0990 for pro-rated dues. If you have trouble printing this page, you may do so by using Control "P".
Please enter the information requested below clearly, accurately, and completely so we will have an up-to-date record in our files and on our web site. Your accuracy helps us to distribute correct information when answering the hundreds of referral and relocation requests we handle each year.
* Please refer to the following chart for your dues amount *
| Employees | Dues | Employees | Dues |
| 1 (Individual) | $64 | 26-50 | $244 |
| 2-5 | $92 | 51-100 | $307 |
| 6-10 | $122 | 101-200 | $365 |
| 11-15 | $185 | 201-300 | $428 |
| 16-25 | $214 | over 300 | $486 |
| Company Name | ||||
| Mailing Address | ||||
| Street Address | ||||
| City | State | Zip | No. Employees | |
| Phone | Fax | Other | ||
| Web Site Address | ||||
| Contact Person | Title | |||
| Owner/President | Business Type | |||
| Signature | Title | Date | ||
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Please contact me to help on a committee or yearly event. (Check Yes or No) Do you currently have a Membership Plaque? A $25 fee will be charged for Non Sufficient Funds checks |
Yes |
No No |
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