Membership Application

Chamber Dues Structure * Valid from January 1st thru December 31st
1 - 3 Employees 4 - 10 11 - 25 26 - 100 Over - 100 Schools, Churches, Civic and Non-Profit Individuals	$65.00/yr $110.00/yr $220.00/yr $330.00/yr $440.00/yr $55.00/yr $40.00/yr
Please complete and mail to Union County Chamber of Commerce - 330 South Main Street - Anna, Illinois 62906 Make your check payable to the "Union County Chamber of Commerce" * Dues are pro-rated throughout the year. If you are joining mid year call 618-833-6311 for correct dues amount. Name of Firm: _______________________________________ Contact Person: ______________________________________ P.O. Box: __________________________________________ Street Address:_______________________________________ City, State & Zip Code: _____________________, ___________ ____________ Number of Employees: __________ \| Date: ___/_____/_________ Home Phone: _____ - _____ - _______ \| Business Phone: _____ - _____ - _______ Fax Number: _____ - _____ - _______ E-mail: ________________ @ ___________________ Web Site Address: _______________________________________ Products and/or Services Sold: ___________________________________________________________________ Please use the back of this form or a blank sheet of paper to include comments. You may also include 50 to 75 words describing your business. This will accompany your business name and contact information on our Chamber web site. Should your information change it will be your responsibility to inform the Chamber of needed corrections. Pursuant to the Revenue Act of 1987, we are required to advise you that your investments into the Union County Chamber of Commerce is not deductible as charitable contribution for federal income tax purpose. However, your dues are deductible as a business expense to the extent otherwise permitted under law.