Greater Shreveport Chamber of Commerce Member Application

* Required Fields

Organization Information (to be displayed online)
Organization Name *
Business Established
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Fax
Website
Email *
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Title
Phone *
Email *
Additional Contacts
Billing Address (if different)
Street
City
State
Zip
Mailing Address (if different)
Street
City
State
Zip
Additional Information
Business Ownership Type:
(Select al that apply)


Referred by
How did you hear about us?
Reasons for joining
(You may select more than one)
Networking/Referrals
Educational Opportunities
Increased Visibility/Exposure
Legislative/Public Policy
Volunteer Opportunities
Diplomats
Economic Development
Business Development Connection (BDC)
Service Core of Retired Entrepreneurs (SCORE)
Government Procurement (GPC)
Young Professional Initiative (YPI)
Other
What do you hope to gain from your membership?
Social Networking:
(Enter the http:// URL for your homepage on each site you utilize)
Facebook
Twitter
LinkedIn
Membership Investment
Business Classification:
Business Description for the
Online Business Directory
(Limited to 120 characters)
Membership Type: *
(Membership levels are based on number of employees for most businesses. Once you enter your employment count below, your investment amount will auto-calculate for you)
Primary Directory Category *

Secondary Directory Category (cost $75)

Employment Count
(Count is subject to verification and investment amount may be adjusted accordingly)
Number of Full Time Employees:  
Number of Part Time Employees:  
$ 
   
$ 
Total: $ 

*For detailed information on Premium level memberships, or any other questions, please contact Membership Department at 318.677.2521

Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
Enhanced Membership ($50):
$ 
*
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
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Credit Card Information
Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Please click submit only one time.  The transaction may take several seconds.