Member Application
Business Information
Company Name:
*
Leave Blank:
Phone:
*
Website:
Email:
*
Business Description (200 char max):
*
Directory Category:
--- Select Primary Category ---
Accounting
Advertising, Marketing, & Media
Alternative Medicine/Wellness
Apartments
Automotive
Awards/Trophies
Banking
Beauty Consultants
Breweries
Building & Construction
Business & Professional Services
Business & Professional Services
Catering
Cellular/Wireless Service
Child Care
Churches & Worship
Cleaning Services
Clothing
Computer & IT Services
Cybersecurity
Dance Instruction
Defense
Dentists
Eco-Friendly Self-Care
Education
Elder Home Care
Employment
Engineering
Entertainment
Event Venue, Planning & Catering
Financial
Firearms
Floral & Gifts
Food & Beverage
Food Truck
Funeral Home/Cemetary
General Contractors
Health and Fitness
Health Care
Home Furnishings
Home Improvement
Home Repair
Hospitals
Individual
Industry
Insurance
Jewelers
Landscape/Lawn Care
Legal Services
Lodging
Madison City Business *
Manufacturing
Medical
Medical Spa
Mens Hairstylist
Movers/Transport
Music & Arts
News & Radio
Non Profit
Occupational Therapy
Office Furniture & Systems
Online Services
Optometrist/Eye Care
Orthodontists
Pest Control
Photography/Media/Video
Physical Therapy
Physicians
Printing
Property Acquisition & Management
Publications
Real Estate
Recreation
Rental Homes
Restaurants
Retail Shopping
Salons
Schools
Service
Shipping & Storage
Sitters
Speech Therapy
Sports/Sporting
Storage
Transportation
Travel
Veterinarians & Pets
Warehouse Club
Employees:
*
Full-time
Part-time
Business Keywords (enter a space between words):
*
Comments / Questions:
Woman Owned?:
Veteran Owned?:
Minority Owned?:
Physical Address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Mailing Address
Same as physical address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Primary Contact Information
First Name:
*
Last Name:
*
Title:
Phone:
*
Cell Phone:
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
LinkedIn
Facebook
Twitter
Instagram
google+
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Billing Contact Information
Same as Primary Contact
First Name:
Last Name:
Title:
Phone:
Cell Phone:
Fax:
Email:
Contact Preference:
Email
Phone
Login:
Password:
Social Networking:
LinkedIn
Facebook
Twitter
Instagram
google+
Address
Same as Member Address
Line 1:
Line 2
City:
State:
Postal Code:
Country:
--- Select Country ---
Canada
United States
Membership Options
Membership Package:
*
Food Truck
:
$175.00
1 - 4 Employees
:
$325.00
Company with 1 - 4 Full-Time Employees
5 - 10 Employees
:
$400.00
Company with 5 - 10 Full-Time Employees
11-25 Employees
:
$450.00
Company with 11-25 Full-Time Employees
26-50 Employees
:
$550.00
Company with 26-50 Full-Time Employees
51-100 Employees
:
$700.00
Company with 51-100 Full-Time Employees
101-500 Employees
:
$850.00
Company with 101-500 Full-Time Employees
500-1000 Employees
:
$1,250.00
Company with 500-1000 Full-Time Employees
1001-2000 Employees
:
$1,500.00
Company with 1001-2000 Full-Time Employees
Non-Profit
:
$325.00
Non-Profit Organizations
Additional Fees:
Administration Fee
:
$50.00
One-Time Administration Fee (required of all new memberships)
Additional Opportunities:
We will contact you with additional information.
Additional Listings
:
$150.00
Note: Additional Listings must include the primary membership but may have separate contact information. Example:ABC/HVAC/Additional Listing: ABCHVAC/Chimney Cleaning. If 5 or more Additional listings are desired please call the Madison Chamber of Commerce Office for assistance.
Payment Option:
Charge my credit or debit card
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