Application

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Membership is based on the number of full time employees working for your company.

Membership Dues Renew Automatically

Organization Information (to be displayed online)
Primary Contact Person
Additional Contacts
Contact 1
Contact 2
Contact 3
Contact 4
Contact 5
Contact 6
Contact 7
Contact 8
Contact 9
Contact 10
Billing Address (if different)
Mailing Address (if different)
Additional Information
Membership Investment
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  • If you select one or more additional categories, you will be charged an additional $40.00 for each additional listing
 
 
   
 
 
 
 
 
 
 
 
 

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NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information

Name on Card
Security Code
Valid Through
Billing Address
City
State
Zip
Phone
Credit Card Email Address

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Waterbury Regional Chamber Partners