Member Application

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Secondary Directory Category:

Please choose your top 3 reasons for joining:

Business to Business Relations:

Economic Development:

Availability of Health Insurance:

Events:

Continuing Education - Penn State World Campus:

Promotion of Business:

Governmental Advocacy:

Banks and Credit Unions - Number of Locations:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Social Networking:

LinkedIn Facebook Twitter Instagram

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone:

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone:

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Print Application

Greater Susquehanna Valley Chamber of Commerce
2859 N Susquehanna Trail
Shamokin Dam, PA 17876

(570) 743-4100
1-800-410-2880

[email protected]

Website by MoJo Active

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