Business Name__________________________________________________________ Contact Person_________________________________________________________ Street Address_________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Phone Number ___________________ Email Address _______________________ URL/Web Address _______________________________________________________ Membership Type: __ Individual (Retired or Non-Business Member) - $60 __ Non-Profit Organization - $60 __ Individual Contractors (i.e. one realtor of a realty office) - $60 __ Business, 1-4 persons - $120 __ Business, 5-10 persons - $175 __ Business, 11-25 persons - $235 __ Business, 25 or more persons - $350 Method of payment: __ Check (made out to Silverton Area Chamber of Commerce) __ Bill me If billing address is different than business address above, please provide your billing address here: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Please mail your payment to: Silverton Area Chamber of Commerce PO Box 257 426 S. Water Street Silverton, OR 97381