Member - Springfield Regional Chamber

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords * (enter a space between words)

Please add your business keywords.

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Minority *

Looks good!

Referred By

Human Resources Contact

Name *

Looks good!

Phone *

Looks good!

Email *

Looks good!

Marketing Contact

Name *

Looks good!

Phone *

Looks good!

Email *

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Facebook

Twitter

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Step 5:

Membership Package

Please select a Membership Package

Corporate Membership

See fee schedule and enter fee here:

Please enter your fee.

Out of Area Membership

Organization Outside of Hampden County See fee schedule and enter fee here:

Please enter your fee.

Non-Profit Membership

See fee schedule and enter fee here:

Please enter your fee.

Comments/Questions

Payment Option

Charge my credit or debit card

Please complete the Captcha

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Step 4:

Billing Contact

Address

Social Network Addresses

Step 5:

Membership Package

Payment Option

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