Membership Application
RUSSELL COUNTY CHAMBER OF COMMERCE
P.O. Box 64, Russell Springs, KY 42642
Phone 270-866-4333 Fax 270-866-4304
www.russellcountyky.com Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
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2011 MEMBERSHIP RENEWAL
BUSINESS: __________________________________________________________________
ADDRESS: __________________________________________________________________
CITY, STATE, ZIP:_______________________________________________
CONTACT PERSON: ___________________________TELEPHONE: ________________
WEBSITE:www._________________________________EMAIL_______________________
MEMBERSHIP INVESTMENT SCHEDULE
INDIVIDUAL $ 50.00
PROFESSIONAL $ 85.00
SPONSORSHIP $300.00 Minimum
FINANCIAL INSTITUTION $ 10.00 per million ($500.00 Max.)
BUSINESS PER SCHEDULE
INDUSTRIAL PER SCHEDULE
# OF EMPLOYEES INVESTMENT AMOUNT
1----- 5 $ 85.00
6 --- 10 $110.00
11--- 20 $140.00
21--- 50 $200.00
51-- 100 $250.00
101-- 200 $375.00
Over 200 $500.00
CATEGORY/BUSINESS CLASSIFICATION
______AUTOMOTIVE ______NON-PROFIT
______BROADCASTING ______PROFESSIONAL
______CONSTRUCTION ______PUBLISHER/PRINTER
______FINANCIAL ______REAL ESTATE
______HOTEL/MOTEL/APTS. ______RESTAURANT
______INDIVIDUAL ______RETAIL
______INDUSTRIAL ______SERVICE
______INSURANCE ______SPONSORSHIP
______MANUFACTURER ______TRANSPORTATION
______MEDICAL ______ UTILITIES
______OTHER
Signature: __________________________________Date: ______________
