Application for Membership Lake Providence Chamber of Commerce

Application for Membership

I desire to become a member of the Lake Providence-East Carroll
Chamber of Commerce for the year April 2008-April 2009.

I have read and agree to abide by the organization's
terms and conditions of membership.

______ $25.00 - Individual Membership

______ $40.00 - Couple (Individual and Spouse) Membership

______ $50.00 - Non-profit Organization/Church

______ $75.00 - Business (1-8 employees)

______$120.00 - Business (9+ employees)

______ $5.00 - Junior Chamber of Commerce (15-18 years old)

____________________________________________ NAME

____________________________________________ BUSINESS NAME

____________________________________________ ADDRESS

____________________________________________ TELEPHONE

____________________________________________ EMAIL

____________________________________________ OTHER CONTACT INFO

____________________________________________ SIGNATURE (required)

Please print the application, fill in all blanks.
mail application with your check or money order to:

Lake Providence-East Carroll Chamber of Commerce
Attention: Mary Jane Knight
600 Lake Street
PO Box 28
Lake Providence, LA 71254

If you have questions, please call: (318) 559-0485

Lake Providence - East Carroll Chamber of Commerce
600 Lake Street, US Highway 65
Lake Providence, Louisiana 71254
Telephone: 318-559-5125
www.lakeprovidencechamber.org