Membership Application

Standard Membership Fee:
$160
Gold Membership Fee:
$210

Thank you for your interest in joining the Greene County Chamber of Commerce. To apply, simply fill out and submit the on-line application below.

Our standard membership annual fee is $130 plus a one-time $30 administrative fee for new applicants. Gold-level membership is $50 more per year, or $180. A Gold Membership provides additional recognition on our website and social media as well as recognition at various events during the year. We also pro-rate our fees on a monthly basis as reflected in the current price box to the right.

So please feel free to join at any time! Also consider paying the registration fee safely and securely through our on-line payment system. Simply select “PayPal” as your payment option below and you will be sent to a page that will let you use your credit card to apply right away. It is free, 100% secure, and you are not required to have a PayPal account. Of course you can also choose to mail a check or money order to the address provided below.

We appreciate your interest in membership, and we look forward to working with you.

Note: There are two (2) contacts standard per membership, but more are permitted. Please let us know if you require additional contacts.

Note: If you are a previous Chamber member and have allowed your membership to lapse, you must sign up and pay the same rate as a new member. This is to cover the time required for account administration.

Membership Application Form

Business Name *

D.B.A. Name

Street Address *

Street Address

City

State

Zip

Mailing Address (if different)

City

State

Zip

Business Phone *

Fax Number

Primary Contact Information

Name *

Title *

Email *

Secondary Contact Information

Name

Title

Additional Company Information

Web Address

Year Founded *

Number of Full Time Employees *

Number of Part Time Employees *

Business Summary for inclusion on Chamber Web Site: *

(max 500 characters)

Choose Primary Category *

Choose Secondary Category

Submitted by: *

Date *

Payment Method *

Choose Membership Level:

List the business that referred you, if any:

Security

If you are human, leave this field blank.

PLEASE click “Apply Now” only once
and allow several seconds for your request to process.

Send Remittances to:
Greene County Chamber of Commerce
P.O. Box 643
Ruckersville, VA 22968