Business Name:

Street Address: City: State: Zip: -

Mailing Address: City: State: Zip: -

Telephone: () -       Fax: () -

Do we have permission to communicate through FAX? YesNo

E-Mail:       Company Website:

Business Classification:

Number of Full-Time Employees:

Number of Part-Time Employees:

Main Contact : Title:

You may designate the following people to be representative members of the Chamber of Commerce. The "Main Contact" listed above will receive all Chamber mailings. If you would like others to receive mailings as well there will be an additional fee of $15.00 per person. E-mail communications are available at no additional cost.


Name: E-Mail: To Receive Mail? YesNo

Address: City: Zip: -


Name: E-Mail: To Receive Mail? YesNo

Address: City: Zip: -


Sponsor/Recruiter:

Membership dues for the Madera District Chamber of Commerce paid by your business are TAX DEDUCTIBLE as an ordinary and necessary business expense, not as a charitable deduction for federal tax purposes.

1% of your Chamber dues are not tax deductible to the extent that the Chamber engages in state and/or federal lobbying.

Signature: Title: Date: //