The Cape Cod Canal Region Chamber of Commerce would like to thank the following sponsors:

Cape Cod Canal Regional Chamber

Membership Application

Who referred you to the Chamber?
Business Name:
Published Address:
City:
State:
Zip:
Mailing Address (if different):
First Name:
Last Name:
Work Telephone:
Home Phone:
E-Mail:
Fax:
Website:
Number of Employees:
Full Time:
Part Time:


If Applicable:

Number of Rooms/Units:
Number of Tables:

Employee e-mails for monthly newsletter, networking events & business seminars:

First Name:
Last Name:
E-Mail:

First Name:
Last Name:
E-Mail:

First Name:
Last Name:
Email:

Business Category (Included with membership)
Optional ~ Second Business Category (Additional fee $75)

Are you interested in serving as a volunteer on a Chamber Committee? Yes No

Main Reason for joining the Chamber: (check below all that apply)

Networking
Education
Political Advocacy
Insurance
Advertising & Marketing
Web Presence


Payment Options


Please calculate your investment by adding the following items the Membership Investment Schedule
Annual Fee: $
Second Category Fee: $
Total Investment: $


Payment Option
Check Number:         

Credit Card Type:
Credit Card#                    
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number
Credit Card Country
Credit Card Email Address
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