(check one)
New_____________
Renewal__________
Buisness Name___________________________________________________________________
Addres:__________________________________________________________________________
City-State-Zip_____________________________________________________________________
Phone:______________________________________FAX:_________________________________
Contact Person_____________________________________________________________________
Type Of Buisiness Or Organization:____________________________________________________
E-mail Address:_____________________________________________________________________
Membership Dues:(circle one)
Business:-------------------------------------------$30.00
Associate-------------------------------------------$10.00
Nonprofit--------------------------------------------$25.00
Please Print out Complete and return to:
Nashwauk Area Chamber Of Commerce
PO Box 156
Nashwauk Mn 55769
Size of Date Sticker on Plaque(please Check one)
