Greater Coachella Valley Chamber of Commerce

Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (1500 char max): *

Directory Category: *

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Ambassador:

Your Representative: *

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter googlemybusiness Instagram YouTube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter googlemybusiness Instagram YouTube

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Level 2 - Non Profit Organization: $310.00
Level 3 - Small Business & Elected Officials: $360.00
Level 4 - Community : $610.00
Includes Country Clubs, Apartments, Attractions, Hotels Less than 99 Rooms, RV Parks Level 5 - Regional: $710.00
Includes Developers, Media, Utilities, Auto Dealers, Hospitals, Hotels With Over 100 Rooms, and Large Retail.

Additional Fees:

Administrative Fee : $45.00
One-time fee at start of membership

Payment Option:

Bill me Charge my credit or debit card

I have read and accept the privacy policy of The Greater Coachella Valley Chamber of Commerce. I grant The Greater Coachella Valley Chamber of Commerce permission to contact me regarding my account, news, updates, and offers.