pagosa springs chamber

Pagosa Springs Chamber of Commerce Membership Application

   
Directory Information (to be displayed online)
Organization Name *
Physical Address 1 *
Physical Address 2
City *
State *
Zip *
Organization Phone *
Organization Toll-Free Phone *
Organization Cell Phone
Organization Fax
Organization Website
Organization Email *
Organization Description
Provide a description about your business and/or services you provide (1000 characters for a basic membership - 1500 for an enhanced membership)
Driving Directions
Hours of Operation
Keywords
(8 keywords for a basic membership - 20 for an enhanced)
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Year business established:
Would you prefer your mailing or physical address on the website or both?
Please list other businesses you own:
User Name Requested:
Password Requested:
Referred by
How did you hear about us?
What is your reason for joining?
Please have someone contact me regarding
*Check all that apply
Business Resources
Community Involvement
Cost Savings Programs
(Insurance, Office Supplies, Worker's Compensation)
Economic Development
Government Relations
Networking
Other           
Membership Information
Membership Level: *

*Professional Associate: Representatives of a business who work as independent contractors, outside sales reps or other non-employee persons who represent a company.

*Individual Associate: An individual or family who wants to support the local business community. They are eligible for membership discounts but there is no advertising for this membership level.

*Diplomat: Volunteer of the Chamber who goes through training and signs a commitment letter to work.

Primary Directory Category *
Additional Directory Categories
  • Primary Dirctory listing is complimentary
  • Additional Directory listings are $25 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Full Time Employees:  
Number of Part Time Employees:  
Enhanced Membership ($100):
Includes logo and picture on the website listing, 1500 characters in business description and 20 keywords for better placement on the search engine.
   
$ 
$ 
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Annual Dues
tempValue1
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
AdditionalCategories
Additional Categories Cost
Enhanced Membership Cost
Tax
Fee
Number of Rooms (Hotels and Motels):  
$ 
*
Credit Card Information

Secured Transaction This process uses the latest SSL security encryption.

Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number
Please click submit only one time.  The transaction may take several seconds.

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