Member Application

The Mission Statement is to enhanced the success of business, tourism, and civic interests of Polk County and to promote the quality of life for all citizens. All applications are reviewed by the Board of Directors. Membership begins when the investment is received in the Chamber office.

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

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

Step 2:

Additional Info

Business Description (200 char max)

Business Keywords (enter a space between words)

Directory Category *

Please select a directory category.

Full-time Employees

Part-time Employees

ReferredBy

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

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

Address line 2

Country

City

State

Postal Code

Facebook

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

State

Postal Code

Social Network Addresses

Create Account

Password *

Please add your login password.

Back Next Submit Application Print Application

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Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Social Network Addresses

Create Account

Step 5:

Membership Package

Payment Option

Upcoming Events

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Additional Resources

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