Broken Arrow Chamber of Commerce

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If you are interested in joining the Chamber, please complete the following information. Upon Submit, you will have the opportunity to pay via credit card.

Date:

Example: 01/11/2012

Business Name:

Primary Contact Name:

Primary Contact Title:

Primary Contact Email:

Business Phone:

Example: 918-555-5555

Secondary Contact Name:

Secondary Contact Title:

Secondary Contact Email:

Other Contact Name:

Other Contact Email:

Other Contact Name:

Other Contact Email:

Fax:

Example: 918-555-5555

Business Address:

City:

State:

Zip Code:

Billing Address (if different than address above)

Street Address:

City:

State:

Zip Code:

Company Website:

Company Facebook:

Company Twitter:

Business Email:

Are you a Minority or Women Owned Business?
Yes
No

Are you interested in learning about Leadership Broken Arrow?
Yes
No

Date Business was established:

Description of Business:

Five Key Search Words:(for chamber website)

Chamber Member Benefits: please check all that interest you
Networking Advocacy Employee Recruitment Economic Development Training
Leads Groups Publicity Community Support Chamber Choice Other
Other (please explain):

Number of Employees / Business Type:

Total Membership Dues:

If you should have any questions concerning this form, contact April Sailsbury at 918-251-1518 or contact us by email.

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