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Application for Membership

To maximize our value to your organization, complete the following information. Your response will enable us to activate your company’s official membership file. The Kentucky Chamber will use this data for official purposes only. This information will be used in our annual membership directory.

* indicates mandatory field

*Contact First Name:  
*Contact Last Name:  
*Title:  
*Address:  
 
*City/State/Zip:   State:    Zip:
*Phone:  
Fax:  
*Email:  
*Web Site:  
Member Local Chamber?

  Yes   No
Name of Local Chamber
*Primary Line of Business:        *4-digit SIC Code:
                                                                             (What's This?)

Additional Contact Information

   Government/Public Affairs Name:  
Title:  
   Human Resources Name:  
Title:  
   Finance Name:  
Title:  
   Safety/Environmental Name:  
Title:  
   Marketing Name:  
Title:  
   Other Name:  
Title:  

Please Select Areas of Interest

Please select the areas that you are interested in so we can communicate with you more effectively.

Education & Workforce Development

Government Efficiency

Health Care & Wellness

Kentucky Competitiveness

Energy & Environment

Small Business

Manufacturing

Investment Schedule

Please calculate your investment based on the number of employees in Kentucky. Two part-time employees equal one full-time employee.
 

*Number of Employees:    

Basic Membership $350 + $8 per employee
Equity Partners $2500 + $8 per employee
Trustees $5000 + $8 per employee
Presidential Advisors $10,000 + $8 per employee
Chairman's Circle $25,000 + $8 per employee
Commonwealth Partners $50,000 + $8 per employee

 

INVESTMENT TOTAL
 		  
with employees $

Application Fee (one-time fee)
 
$25.00
 

TOTAL
$

 

I understand that by providing the fax number and e-mail address above, on behalf of the organization specified above, I am authorized to and hereby consent for the organization to receive faxes and e-mails sent by or on behalf of the Kentucky Chamber of Commerce.
 
Yes, I understand that I will need to contact my legislator on behalf of Kentucky businesses when the Chamber issues an Action Alert. Contact your legislator at 800-372-7181.
 
 

Home Address Zip Code:
(needed to send information related to your legislative district)