Member Application

Thank you for your interest in the La Verne Chamber of Commerce. Please fill out the application and join our group for some great networking and community involvement.

Business Information

Company Name: *

Phone: *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

0-5 Employees: $280.00
6-10 Employees: $325.00
11-25 Employees: $385.00
26-50 Employees: $480.00
51-100 Employees: $540.00
100+ Employees: $610.00
Non Profit Orgaization: $190.00
For Non Profit Organizations with all volunteer staff

Payment Option:

Charge my credit or debit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 7 plus 1?: *

Print Application