Membership Application - Winfield, KS Chamber of Commerce

Name of Business *

Name of Firm's Representative *

Is the Representative the: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Fax

Website *

When was this business established? *

Would you prefer to be billed for your chamber dues: *

Number of Full-Time Employees *

Number of Part-Time Employees *

Names and email addresses of other representatives who would like to receive chamber correspondence:

Business Description *

If statements are to be sent elsewhere, please give proper address:

Would you like to learn more about the Chamber's BEST Retail Committee? *