Affiliate Referral Submission

Your Full Name*
Your Email*
Phone Number
Current Relationship to the Chamber*
New Member Information
Company Name*
Please enter information about the referral
Full Name of Business Owner / Representative*
Sign Up Date / Expected Sign Up Date*
MM slash DD slash YYYY
Notes or Comments
Terms & Conditions
- You will receive $25 in chamber credit
- The new member will receive $25 in chamber credit
- The referral fees will be credited to your chamber account and can be used towards your membership payment, luncheons or events.
- Referral credits only apply to new memberships (no renewals)
- Referral credits are only applied after full membership payment is received from referral
- New refferal submissions must be made within 15 days of membership sign up
Do you agree to the terms and conditions?*
- I agree to the terms and conditions

New Member Information