Membership Application

The Darien Chamber of Commerce is delighted to welcome you to our organization!  After reviewing the 2016 Membership Dues Schedule , please submit the form below to initiate your membership.  If you need further definition of the membership categories, please click on [Join the Chamber] in the right hand column.

New Members – Please include an additional $35.00 one-time-processing fee and $10 to Darien Chamber Of Commerce  Scholarship Awards Fund.

 

Annual Dues:*

 1 Employee $250 2-5 Employees $300 6-15 Employees $400 16-25 Employees $500 26-50 Employees $600 51-75 Employees $700 76-100 Employees $900 Realtors Office $450 Utilities $725 Non-Profits $150 Media $600


Number of Full-Time Employees:

Number of Part-Time Employees:

Number of Volunteers:

BUSSINESS INFORMATION
This information will be viewable on the Chamber web site.

Bussiness Name

Business Description:

Address 1: *

Address 2: *

City:*

State: *

Zip Code:*

Phone Number: *

Email:

Optional - This email address will appear on the Chamber web site.

Web Site:
http://www.

This information will NOT appear on the Chamber site.

Owner Name: *

This information will NOT appear on the Chamber site.

Secondary Email: *

This email will only be used for internal communication and will not appear on the Chamber web site.

Primary Contact: *

If not the owner.

Primary Phone:

Home City:

Home State:

Electronic Signature:

date:*

Word verification: *

Answer the question and then submit the form