Welcome and thank you for applying for membership in The Greater Fort Wayne Chamber of Commerce. All membership applications are subject to approval.

Member Application:

* Company Name:

* Phone:

Website:

* Email:

Business Description (200 char max)

Business Keywords:

* Physical Address:

* City/State/Zip:

Country:

Mailing Address:

Same as physical address

City/State/Zip:

Country:

* Business Category:

* Employees:

Full-time: Part-time:

Comments/Questions:

Primary Contact Information:

* Name (First / Last):

/

Title:

* Phone:

Cell Phone:

Fax:

* Email:

Contact Preference:

Email Phone

Social Networking:

LinkedIn:

Facebook:

Twitter:

Address:

Same as Company Address

City/State/Zip:

Country:

Billing Contact Information:

Same as Primary Contact

Name (First / Last):

/

Title:

Phone:

Cell Phone:

Fax:

Email:

Contact Preference:

Email Phone

Social Networking:

LinkedIn:

Facebook:

Twitter:

Address:

Same as Company Address

City/State/Zip:

Country:

Membership Package:

	General Business Firm: See fee schedule to determine the fee and enter it below. General Business Firms
	Professional Firms: See fee schedule to determine the fee and enter it below. Professional Firms
	Non-profit Organization 1-50 employees: $360.00 1-50 employees
	Non-profit Organization 51-200 employees: $540.00 51-200 employees
	Non-profit Organization 201+ employees: $1,040.00 201+ employees

If using fee schedule, enter fee here:

Additional Fees:

$25 Application fee
One time membership application fee

Payment Option:

Charge my credit card

Submit Application:

Enter the CAPTCHA words, then press the Submit Application button.

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