Please choose a membership level and complete the required (*) fields below. Chamber Membership(Required)The chosen membership level that you are applying for with the Northeast Kansas City Chamber of CommerceIn Home Business/ArtistK-12 School/Church0-4 employees5-10 employees11-20 employees21-49 employees50-199 employees200+ employeesTest MembershipMembership Level TotalThe price below is the total cost of membership for one year. Business(Required)Please enter the name of the business. This name will be displayed on the Chamber of Commerce website.Business CategoryPlease select a category that best represents your business or organization. Accounting/Finance Advertising/Public Relations Aerospace/Aviation Arts/Entertainment/Publishing Automotive Banking/Mortgage Business Development Business Opportunity Clerical/Administrative Construction/Facilities Consumer Goods Customer Service Education/Training Energy/Utilities Engineering Government/Military Green Healthcare Hospitality/Travel Human Resources Installation/Maintenance Insurance Internet Job Search Aids Law Enforcement/Security Legal Management/Executive Manufacturing/Operations Marketing Non-Profit/Volunteer Pharmaceutical/Biotech Professional Services QA/Quality Control Real Estate Restaurant/Food Service Retail Sales Science/Research Skilled Labor Technology Telecommunications Transportation/Logistics Other Contact InformationThe fields below will be associated with your membership and used for contact purposes.Contact Name(Required)Please enter the contact person for this business or organization. First Last Contact Person Title(Required)Please enter the title of the contact person listed above.Contact Phone(Required)Please enter the phone number of the account contact.Contact & Billing Address(Required)Please enter the address of the contact person for this business or organization. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required)Please enter and confirm the E-mail address of the contact person for this business. Enter Email Confirm Email Is the business address the same as above?(Required)Is the business address the same as the contact person's address? Yes No Public InformationThe fields below will be displayed to visitors to the membership directory on our website.Business Organization AddressPlease enter the address of the business or organization. This address will display on the Chamber of Commerce website. Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Public Address Opt-out(Required)Indicate whether or not you want to have your business address displayed on the chamber website and map. I DO NOT want my address displayed I DO want my address displayed Phone(Required)Please enter you're organization's contact phone number.FaxPlease enter the fax number of the business.WebsitePlease enter the website address of the business. Website must be in the following format: http:// Twitter ProfilePlease enter the Twitter handle/username of your business or organization if applicable.Facebook URLPlease enter the Facebook URL of your business or organization page if applicable. Must start with http(s):// Business LogoPlease upload an image of your logo or business if applicable. (Recommended size: width: 225px; height: 150px) 16MB LimitAccepted file types: jpg, gif, png, tiff, Max. file size: 16 MB.Business IntroductionPlease write a welcome with a brief introduction about your business or organization.Total Select to checkout with either PayPal or Credit Card below. After completing the fields above click on the PayPal button to enter and complete payment.Payment Method(Required)PayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
