Forms • City of Levelland • CivicEngage

Levelland Chamber of Commerce Membership Application

Leave This Blank:

Company/Organization Name:*

Physical Address:*

Mailing Address:*

City:*

State:*

Zip:*

Phone:*

Fax:

Website:

Primary Contact:*

Title:

Phone:*

Email:

Birthday:

Alternate Contact:

Title:

Phone:*

Email:

Birthday:

Membership Directory Listing Category:*

Description of Company:

Membership Investment:*

Why did you join the Chamber of Commerce?
(Please check all that apply)*

	Networking Opportunities
	Advertising/Promotional Opportunities
	Legislative Representation

	Community Programs/Involvement
	Other (please specify)

Please specify if you answered 'other' in the question above:

Can we post your email and website addresses on our website?*

	Yes
	No

	Website Only
	Email Only

* indicates required fields.