Membership Application

OUR MISSION:
To promote a strong economy
and high quality of life for our
chamber members and the
Cross Plains area communities.

A printable membership application can be downloaded by clicking here.

CROSS PLAINS AREA CHAMBER OF COMMERCE

20011 MEMBERSHIP APPLICATION

Please complete all the information below (this information is used to keep our records current and some of the information will be posted on the website directory; crossplainschamber.net.) Please include your E-mail address so that we can send notices via E-mail and reduce mailing costs. Please contact Amy Hansen at cpbaexecdir@yahoo.com or (608) 843-3166 if any questions or comments. Thank you. Please return this portion with your payment.

Business Name: _____________________________________________________________________

Primary Representative: ________________________________Title:___________________________

Secondary Representative: _____________________________ Title: ___________________________

Business Address: ___________________________________________________________________

Number of Employees: __________________ Phone: _______________________________

E-mail Address: ___________________________ Website Address: __________________________

Type of Business: ___________________________________________________________________

Total Remittance Enclosed: ________________ Member Signature: ____________________________

TEAMS - PLEASE JOIN ONE OF THESE TEAMS BY MARKING YOUR CHOICE

(this is a great opportunity for employees of your company to participate and represent your business)

Golf Outing/Sponsorship Chicken Barbeque Hosting Networking Event World’s Fair

Santa’s Visit/ Easter Egg Hunt CPACC Scholarships Website/Newsletter Sponsorship/Advertising

Business Expo Other ideas __________________________________

Please make checks payable to Cross Plains Area Chamber of Commerce (CPACC) and send to PO Box 271, Cross Plains, WI, 53528

Please retain the lower portion for your records.

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Membership Investment

*Individuals $60

Non Profits $100

Sole Proprietors $125

**2-5 Full Time Employees $160

**6-20 Full Time Employees $185

**21-50 Full Time Employees $225

**51-100 Full Time Employees $335

**101+ Full Time Employees $550

Your prompt remittance is appreciated!

TOTAL 2011 Dues Paid____________________________

*Requirements for an Individual Membership include: (subject to change)

· This is a membership for private individuals who are not promoting a business venture.

· Individual must not be self-employed.

· Individual does not receive these member benefits:

Listing in community guide or on chamber website, sponsorships/donations or advertising benefits, cannot represent a company in any form - in member listing, at chamber events via business cards/nametag or other company identification; cannot purchase booth space at an event representing a business.

· Individual can participate in networking, volunteer on board or committee & will receive member newsletter & communications.

**A Full Time Employee is considered as 30 hours or more per week.

CPACC Mission Statement: Promoting a strong economy and high quality of life

for our Chamber members and the Cross Plains area community.

For Chamber Information please email Executive Director, Amy Hansen or call 608-843-3166
PO Box 271
Cross Plains, WI 53528