Membership Application

2. 

4. Business

6. Contact Person

7. Title

9. Mailing Address

11. City

12. State

13. Zip Code

15. Billing Address

17. City

18. State

19. Zip Code

21. Phone Number

22. Fax Number

24. Website

25. Email Address

27. Description of Business

29. Billing Representative ( If Different)

31. Contact Person

32. Title

34. Address

36. City

37. State

38. Zip Code

40. Phone Number

41. Fax Number

42. Email Address

44. Membership Levels

46. Non Profit Organization

    1. $150

47. Business Level (1-10)

    1. $300

48. Business Level (11-30)

    1. $450

49. Business Level (31-100)

    1. $700

51. Emerald Level*

    1. $1000

52. Diamond Level*

    1. $1500

53. Platinum Level*

    1. $2500

55. Payment is Attached

57. Please Send Invoice

59. Pay by PayPal Via Phone 575.623.5695

61. Submit your payment to the: Roswell Chamber of Commerce 131 W. 2nd St. Roswell, NM 88201

    Submit your payment to the: Roswell Chamber of Commerce 131 W. 2nd St. Roswell, NM 88201

63. If you would like more information on the Emerald, Diamond and Platinum level membership, please contact the Roswell Chamber of Commerce.

    If you would like more information on the Emerald, Diamond and Platinum level membership, please contact the Roswell Chamber of Commerce.

Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field