MEMBERSHIP APPLICATION
*Required Fields in Red
Business Information
Business Name:
Primary Contact:
  (Listed in online Membership Directory and receives mail.)
Primary Contact Title:
Street Address:
City:
State:
Zip Code:
Mailing Address if different from above:
City:
State:
Zip Code:
Primary Phone:
Cell:
Fax:
Web Address:
E-mail Address:

Employee Information (excludes primary contact)
Number of Full Time Employees:
Number of Part Time Employees:

Membership Category:
        General Membership
        Financial Institution
        Hotel/Motel
        Individual Membership*
        Charitable Organization
        Out-of-County Business

*Applies to retired business executives and/or individuals not affiliated with a business
 

Mail payment to:
Portage County Business Council
Attn: Membership Dues
5501 Vern Holmes Drive
Stevens Point, WI 54482
 
Additional Information
Please describe your business in 25 words or less.
I am joining the Chamber because:
Do you know of any other businesses that would benefit from membership?
 
 
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