Membership Application

Membership

Friend of the Chamber $1,000

Business (51+ employees) $600

Business (16-50 employees) $450

Business (6-15 employees) $350

Business (1-5 employees) $250

Individual $150

Clubs & Organizations $100

Amount Sent

Date of Membership

Information in which membership is carried:

Company

Contact Name

Contact Title

Contact Cell Phone

Mailing Address

Physical Address

Phone

Fax

Date

Please give a brief description of your business.

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Payments can be mailed to 115 N. Washington Ave. Mansfield, LA 71052

For your convenience you may use a credit card with a 3% fee.