Member Application

Please fill out the application to join the Irish Hills Regional Chamber of Commerce. If you have questions about your membership dues, please contact the President/CEO at 592-8907 or cindy@irishhills.com.

Step 1:

Member Info

Company Name * required

Please add your company name.

Phone * required

Please add your company phone number.

Website

Email * required

Please add a valid email.

Physical Address

Address line 1 * required

Please add your address.

Address line 2

Country * required

Please add your country.

City * required

Please add your City.

State * required

Please add your State.

Postal Code * required

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 * required

Please add your address.

Address line 2

Country * required

Please add your country.

City * required

Please add your City.

State * required

Please add your State.

Postal Code * required

Please add your Postal Code.

Social Network Addresses

Facebook

YouTube

Instagram

Step 2:

Additional Info

Business Description (200 char max)

Business Keywords (enter a space between words)

Directory Category * required

Please select a directory category.

Full-time Employees

Part-time Employees

Step 3:

Primary Contact

First Name * required

Please add your first name.

Last Name * required

Please add your last name.

Title

Phone

Cell Phone

Fax

Email * required

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

State

Postal Code

Facebook

YouTube

Instagram

Create Account

Password

Step 4:

Billing Contact

Same as Primary Contact

First Name * required

Please add your first name.

Last Name * required

Please add your last name.

Title

Phone

Cell Phone

Fax

Email * required

Please add a valid email.

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

State

Postal Code

Social Network Addresses

Create Account

Password

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Social Network Addresses

Create Account

Step 5:

Membership Package

Additional Options:

Payment Option

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