Membership Application (Non-Profit Organization)

Date: _____________

Organization Name: _________________________________________________

Primary Contact Name / Title: __________________________________________

Alternate Contact Name / Title: _________________________________________

Mailing Address: ____________________________________________________

City: _______________________________________ State: _____ Zip: ________

Street Address: _____________________________________________________

City: _______________________________________ State: _____ Zip: ________

Telephone: ________________________ Fax: ___________________________

Cellular: __________________________ Other: _________________________

Email: ____________________________ Website: _______________________

Annual Dues:

______ Non-Profit Organization: $75.00

Collinsville Chamber of Commerce
PO Box 245 Collinsville, OK 74021
Phone/Fax: (918) 371-4703
Email: info@collinsvillechamber.net

Be a Chamber Sponsor!
Contact the office for details

Organization Name: _________________________________________________

Establishment Date: _________________________________________________

What is the purpose of your organization? _________________________________

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Why did you decide to open in Collinsville? ________________________________

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Chamber Member Since: ______________________________________________

Have you ever held office with the Chamber, or served on a committee? ___________

_________________________________________________________________

Are you currently a member of any other organizations? _______________________

_________________________________________________________________

Please add any other information you would like us to know about your organization:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

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Note: The information in this profile will be used to help us represent your organization to the community and potential customers.