Coudersport Area Chamber of Commerce

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Membership Application

Type of Membership

Individual Membership for Non-Professional $ 35
Non-Profit Organization, Governmental Agency $ 50

Business & Professional

Introductory Rate for New Members  $50
Businesses with 1 – 5 Employees  $75
Businesses with 6 – 10 Employees  $150
Businesses with 11 – 25 Employees  $250
Businesses with 26 – 50 Employees  $350
Businesses with 51 – 100 Employees  $500
Businesses with 101 – 300 Employees  $750
Businesses with 301 – 500 Employees  $1250
Businesses with 501 or more Employees  $2,000

* Employee is defined as one who works a full-time schedule.

Membership Form

Please use your tab key or mouse to go between fields.
Do not use your enter or return keys before the form is complete.

Please provide the following contact information:
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail (required)
Website URL

Choose one of the following options:

New Membership
Renew Existing Membership

Number of Employees:

Business Catagories & Keywords (see recommended options below):

Accommodations / Apartments / Motels / Hotels / Bed & Breakfast / Townhomes / Art / Automotive / Banking / Financial, Banquet/Meeting Facility, Child Care / Computers / Internet, Construction / Building, Education / Training, Entertainment / Recreation / Financial / Florist / Food / Groceries / Furniture / Beverage / Restaurant / Dining, Health / Fitness / Medical, Industrial / Manufacturing, Insurance / Real Estate / Legal / Media / Optical / Personal Care / Professional Services / Public Services / Mail Services, Shopping / Gifts, Utilities / Antiques / Architect / Restaurant / Accountant / Dentist / Moving / Rental Properties / Winery / Newspaper / Employment / Non-Profit / Hospital / Retail / Flooring / Office Supplies / Printing / Fabric / Quilts & Quilting / Sports & Recreation / Marketing / Consulting / Fitness / Wellness / Telecommunications / Cell Phones / Engineering / Machining / Disability / Benefits / Church

Choose one of the following options:

For security, please enter the below text
(lowercase letters with 3 numbers)

Please send check  Made payable to
CACOC (Coudersport Area Chamber of Commerce)
P.O. Box 261, Coudersport, PA 16915

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