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2013 MEMBERSHIP APPLICATION
Membership Type:
Commercial (1 to 5 employees) - $150.00
Commercial (6 to 20 employees) - $225.00
Commercial (21 to 100 employees) - $325.00
Commercial (over 100 employees) - $450.00
Individual (non-business) - $100.00
An "Individual" is a person who is
not
engaged in any business activity.
This does not include self-employed individuals, independent contractors,
or PCI insurance holders.
Church, Non-Profit or Service Organization - 15% discount
First-Time Member - $25.00 administrative setup fee
CONTACT INFORMATION
Business Name:
Business Category:
Additional Category:
$25.00 additional fee
Contact Name:
Mailing Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Phone:
FAX:
Email:
Website:
Additional Employee/1099 Listing
-
$100.00 additional fee
Contact Name:
Mailing Address:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Phone:
FAX:
Email:
Website:
MISCELLANEOUS
Privacy:
Do
NOT
publish this information in the
Membership Directory or on the Website.
Referred by:
Whitehall Area Chamber of Commerce 1457 MacArthur Rd. Suite 280, Whitehall, PA 18052 Phone 610–432–4130 FAX 610–432–2231
exec@waccpa.org
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