Membership Application

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This field is for validation purposes and should be left unchanged.
Choose an Individual or Business Form
Individual Member
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Business Information
I/We formally request membership with the Hardin County Chamber of Commerce. Information below is for official records and other promotional uses.
Please Choose Listing Type*
- Standard Listing (Standard directory included business name and contact information)
- Enhanced Listing (Receives additional information on business, map, photo gallery and video embed - $100)
Name of Member (Organization or Individual)*
Business Phone Number*
Business Email*
What year was this business established/Opened?*
MM slash DD slash YYYY
Business Fax
Mobile/Alternate Phone
Business Website
Please link your website here.
Business Address*
Street Address Address Line 2 City State ZIP Code
- We have a different billing address
Alternate Billing Address
Street Address Address Line 2 City State ZIP Code
Billing Representative (optional)
First Last
Billing Representative Email
Billing Representative Phone
Employees: Full-Time
Employees: Part-Time
About Your Business*
A quick description of your services offered. This will serve as your intro for the next Chamber Luncheon as well!
Business Type (Category)*
[ Hold CTRL (CMD on Mac) to select multiple entries ]
Your Logo
Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB.

Upload your business logo here
Do you have other images of your business? Add Images Here (up to 6)
Drop files here or

Accepted file types: jpg, jpeg, png, gif, Max. file size: 2 GB, Max. files: 6.
Link to embed video (Enhanced Only)
If you'd like to embed a video, please paste the full link here.
Key Representatives Information
Will you have 1 or 2 Key Representatives?*
- 1
- 2
First Last
Key Representative
Key Rep Email*
Name
First Last
Title
Email*
Contacted By
Payment Options
Payment Option*
- Invoice Me
Hardin Chamber will send an initial invoice that can be paid via check or credit card online here
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