Mayflower Area Chamber of Commerce

Membership Application/Record

_____ Individual ($25) _____ Family ($35) _____ Business ($50)

Business/Name:_______________________________________________________________

Contact Person(s): ________________________________ No. of Employees: ___________

Address: ____________________________________________________________________

City/State: _________________________ Zip: __________ Phone:____________________

Mailing Address (if different from above): ________________________________________

Product/Service Offered: _________________________ Date Established: _____________

Area of Interest: _____________________________________________________________

Would you or your representative be interested in serving on the Board of Directors of the

Chamber ?

Yes: _______ No: _______

Remarks: ___________________________________________________________________

Email Address: _______________________ Website: _______________________________

Applicant’s Signature: ___________________________ Date: _______________________

Please print and mail the completed form with a check for the appropriate dues to:

Mayflower Area Chamber of Commerce

P.O. Box 284

Mayflower, AR 72106