Member

Thank you for considering investing in the La Crosse Area Chamber of Commerce. When you join the Chamber of Commerce you have instant credibility as a company wanting to stay current and invest in its local community. Please complete the below information so we can more quickly engage you in the business community.

Business Information

Company Name: *

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Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Parent Company:

Form of Business:

Is Manufacturing:

Is Global / Exporter:

Is National Company:

Is Importer:

Is Minority Owned:

Is Women Owned:

Year of Founding: *

Is Veteran-Owned:

What do you hope to accomplish with your membership signup ?:

Physical Address

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City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook

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

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Print Application

Member Application

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