Member - Greater Wasilla Chamber of Commerce

Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Business/Non-Profit (0-9 Employees): $250.00
0 to 9 Full Time Employees. Business/Non-Profit (10-19 Employees): $350.00
Business/Non-Profit (20-49 Employees): $550.00
Business/Non-Profit (50-99 Employees): $750.00
Business/Non-Profit (100+ Employees): $1,350.00
Development Partner: $2,500.00
Benefactor: $5,000.00
Political Interest Groups/Politicians: $300.00

Additional Opportunities:

We will contact you with additional information.

Relocation Lead Referral : $75.00
Lead Referral Program for relocation information requests made to the GWCC. Vistor Information Lead Referral : $150.00
Lead Referral Program for visitor information requests made to the GWCC

Payment Option:

Charge my credit or debit card

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