Member - The Brillion Area Chamber of Commerce

Member Application

If you are applying as a new member please complete this form. After you complete "Step 1" on the form click on the "Step 2" button, etc. There are 5 steps to complete your form. Once you complete Step 5, click on "I am a Robot" to lead you to a secure payment page. Thank you for choosing the Brillion area Chamber of Commerce!!

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *
Please add your company name.

Leave Blank

Phone *
Please add your company phone number.

Website

Email *
Please add a valid email.

Physical Address

Address line 1 *
Please add your address.

Address line 2

City *
Please add your City.

State *
Please add your MN.

Postal Code *
Please add your Postal Code.

Country *
Please add your country.

Mailing Address

Same as physical address

Address line 1 *
Please add your address.

Address line 2

City *
Please add your City.

State *
Please add your MN.

Postal Code *
Please add your Postal Code.

Country *
Please add your country.

Social Network Addresses

LinkedIn

Facebook

Step 2:

Additional Info

Business Description (200 char max) *
Please add your company description.

Business Keywords * (enter a space between words)
Please add your business keywords.

Directory Category

Full-time Employees *
Please add your number of full-time employees.

Part-time Employees *
Please add your number of part-time employees.

Do You Accept Chamber Bucks *
Looks good!

Chamber Bucks Sponsor *
Looks good!

Advantage Card Discount Offer *
Looks good!

Chamber Sponsorship Information *
Looks good!

Step 3:

Primary Contact

First Name *
Please add your first name.

Last Name *
Please add your last name.

Title

Phone *
Please add your phone number.

Cell Phone

Fax

Email *
Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Address in Step 1

Address line 1 *
Please add your address.

Address line 2

City *
Please add your City.

State *
Please add your State.

Postal Code *
Please add your Postal Code.

Country *
Please add your country.

Social Network Addresses

LinkedIn

Facebook

Create Account

This Login is already in use

Login *
Please add your login username.

Password *
Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *
Please add your first name.

Last Name *
Please add your last name.

Title

Phone *
Please add your phone number.

Cell Phone

Fax

Email *
Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Primary Contact Address

Address line 1 *
Please add your address.

Address line 2

City *
Please add your City.

State *
Please add your MN.

Postal Code *
Please add your Postal Code.

Country *
Please add your country.

Social Network Addresses

LinkedIn

Facebook

Create Account

This Login is already in use

Login *
Please add your login username.

Password *
Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

Private Citizen $ 50.00

Non-Profit $ 50.00

1-9 Employees $ 150.00

10-99 Employees $ 225.00

100+ Employees $ 1,000.00

Additional Options:

Chamberbucks Sponsorship $200.00 one time
If you would like your logo added to next years Chamberbucks certificates please donate $200 to support Chamberbucks and shopping local.

Comments/Questions

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

Back Next Submit Application Print Application

Business Directory News Releases Events Calendar Hot Deals Member To Member Deals Job Postings Contact Us Information & Brochures Weather Join The Chamber