Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player


Membership Application
Required fields are designated in red with an asterisk*



Name of Business: *
Contact Person:
Mailing Address*
City*
Telephone Number:*
FAX Number:
E-Mail Address:
Website:
BUSINESS CLASSIFICATION*
Please check only one business category in which you would like your company to be listed.
Accountant Fitness Center Radio Station
Ambulance Flooring Retail Sales Real Estate Advertising
Appliance Sales & Rental Food Pantries Real Estate Sales
Attorney Funeral Home Reception/Banquet Facility
Attorneys/Legal Services Furniture & Appliance Rental Recycling
Auto Body Repair Furniture & Appliance Sales Remediation
Auto Sales Garage Door Sales & Supplies Research & Discovery
Awards & Gifts General Contractors Restaurant
Bail Bond Services Gifts Retail Flooring
Bank Government Offices Satellite TV, Radio & Internet
Banquet/Reception Facility Greenhouses School - Primary Education
Beauty Salon Grocers School - Higher Education
Bridal Supply Health Clubs Secretarial Services
Building Supply Heating & Cooling Services Senator
Business Consultant Hospital Septic Tank
Cabinets Human Services Service Organization
Car Wash Hunting Supplies Sewing Supplies
Carpet Sales Industry - Glass Manufacturers Signs
Carpet & Upholstery Cleaning Industry - Plastic Manufacturers Small Business Services
Catering Insulation Contractors Smokers
Central Vacuum Systems Insurance Agents Sporting Goods
Child Care Internet Auctions Stained Glass
Churches Internet Services State Park
City Office Investment Securities State Representative
College Jewelers Stencil Board
Comprehensive Substance Abuse Mental Health Care Services Storage Sheds
Computer Equipment Dealer Mining/Milling Storm Shelters
Computer Repair Mobile Home Services Sunroom Sales & Supplies
Concrete Ready Mix Mortgage Services Telecommunications
Construction Motels/Hotels Telephone Directory
Craft Supplies Natural Gas Supplies Telephone Service Provider
Credit Union Network Service Provider Title Company
Custom Cut Stencils New Business Consultant Trophies & Awards
Daycare Newspaper Typing/ Word Processing Services
Deck Sales & Supplies Non-Profit Organization Veterinary Clinics  
Department Store Office Supplies VFW Posts
Dog Grooming Optometrist Voice, Data & Network Provider
Drug Testing Pawnbroker Web Design
Ebay Retail Payroll Services Web Hosting
Electric Power Supplier Pet Boarding Weight Loss
Electrical Contractor Pet Shop Welcome Service
Employment Services Pharmacy Wigs & Accessories
Facilitators Photographer Window Sales & Supplies
Fencing Sales & Supplies Pre-School Upholstery Cleaning
Financial Advisors Printing Company Other:
Financing Publisher  
Firearms Quilt Sales & Supplies  
If you need a new category please type it here

Amount Paid:
Date Paid:
Retail/ Industry/ Service
Number of Employees
Annual Investment
# Employees Investment
1-3 $50
4-10 $100
11-20 $150
21-50 $175
51-100 $200
101-150 $250
151-200 $275
200+ $300
Professional
(Physicians, Attorneys, Veterinarians)
# Employees Investment
1 Professional $75
2 Professionals $100
Each Additional $50
Maximum $200
Hospitals / Nursing Homes
# of Beds Investment
1 - 120 $150
121+ $250
 
Service Clubs/ Organizations
Annual Investments - $50
Individuals & Retired
Annual Investments - $25
Educational/ Gov't Entities
Annual Investments - $75
Financial Institutions / Utilities
# Employees Investment
1 - 120 $150
121+ $250
   

 

 
Home Board Members Events Join Chamber Contact Us Investors Newsletter Points of Interest Economics
©Park Hills - Leadington Camber of Commerce