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
63. If you would like more information on the Emerald, Diamond and Platinum level membership, please contact the Roswell Chamber of Commerce.
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65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

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