Membership Application
Blackstone Chamber of Commerce
Membership Application


I am applying for membership in the Blackstone Chamber of Commerce. I understand that this membership will be renewed annually unless I provide notice 90 days prior to the renewal date.
Firm Name____________________________________________________________________________________
Contact Person_________________________________________________ Title___________________________
Phone______________________ Fax_____________________ Email__________________________
Business Address________________________________________________________________________________
City_____________________________ State____________ Zip Code_______________________
Mailing Address_________________________________________________________________________________
City_______________________________ State____________ Zip Code_______________________
Web Site URL__________________________________________
Number of Full-time Employees___________________________Annual Investment_______________________
Business Classification for All Directories___________________________________________________________________
Add additional category listing for $10.00.
Date_________________Person most responsible for you joining the Chamber__________________________
Applicant Signature______________________________________

Investment Schedule
Investment is deductible for income tax purposes as a business expense.

Business Memberships:
Business and Industry, Automotive, Construction, Retail, Manufacturing, Transportation, Restaurants, Service, Wholesale, Distributors, Professional.

Employees - Full TimeInvestment
  • 1 - 5
    		• $93.00
  • 6 - 10
    		• $105.00
  • 11 - 20
    		• $138.00
  • 21 - 50
    		• $160.00
  • 51 - 100
    		• $193.00
  • over 100
    		• $270.00
    Associate Memberships:
    Government/Local & State Agencies
  • Local Agencies
    		• $93.00
  • State Agencies
    		• $105.00
    Individual Memberships$27.00
    Couple Memberships$49.00
    Non-Profit Organizations$49.00
    Why Did You Join? We want to know why you are joining the Chamber. It will help us assist you in taking advantage of the benefits and services to which you, as a member, are now entitled. Please check the benefits and services that led you to join.

    ____Networking/Business Contacts
    _____Advertising/Business Promotion
    _____Seminars/Workshops
    _____Leadership Training
    _____Governmental Affairs/Business Advocacy
    _____Other___________________________________

    Areas of Interest: I am most interested in participating in the following projects, check all that apply:
    _____Ambassador Club
    _____Arts & Crafts Festival
    _____Annual Meeting/Silent Auction
    _____Chamber Networking Programs
    _____Chamber Operations
    _____Fireworks For Freedom
    _____Government Affairs/Business Advocacy
    _____Holiday Events
    _____Internet/Website
    _____Leadership Blackstone
    _____Renaissance/Town Preservation

    Memberships will be one year.
    Assigned Members: If your membership investment is $190, you are eligible to have one additional representative receive the Chamber's mailings. If your membership investment is $270, you are eligible to have two additional representatives receive the Chamber's mailings. Please list below the name/names of your assigned representatives.
    Name/Title______________________________________
    Name/Title______________________________________

    This application and investment schedule prints on two pages. Use "8 1/2" by 11" paper.
    Mail or Fax to the Chamber Office:
    Blackstone Chamber of Commerce, P.O. Box 295, Blackstone, VA 23824
    Fax (434)292-1588