Application for Membership

Thank you for your interest in joining the CBICC. The Chamber is here to help your business succeed. You are now among over the 1,000 fellow business and organization leaders in Centre County that are part of the CBICC -- Welcome!

NOTE: This information is used for the membership directory, plaque, newsletter, Web site, and other marketing materials. We do not sell your information to any organization and the information we collect is for CBICC use only. Please contact the office at 814-234-1829 with any questions.

Please type clearly using upper and lower case. Information is entered as printed.

Business Name:
Address:
City:
State:
Zip:
Telephone:
Fax:
Toll Free:
Business Email:
Web site:
# of Employees working in Centre County
(dues based on this #):
Business Category
(Click here to view options):
15 Word Description of Business:
For Membership Directory
Main Contact:
First Name:
Last Name:
Title:
Phone & Ext.:
Email:
Other Contacts:
1.)
First Name:
Last Name:
Title:
Phone & Ext.:
Email:
2.)
First Name:
Last Name:
Title:
Phone & Ext.:
Email:
3.)
First Name:
Last Name:
Title:
Phone & Ext.:
Email:
4.)
First Name:
Last Name:
Title:
Phone & Ext.:
Email:
Top 3 Reasons You Joined (Number Choices 1-3):
Networking Opportunities
Training Opportunities
Economic Development
Financial Assistance
Health Insurance Program
Gov’t Advocacy for Business
Member Discount Programs
Member to Member Benefits
Other:
Membership Dues
Annual Dues (*No business promotion )
Plus Enhanced Web Link
(optional $30/year, more info here):
Annual Heritage 1 Committee Dues
($500/year, more info here)
Please choose one of the following:
Person who recommended you to join:
A $40 one-time administration fee will be charged in addition to your annual dues.
Payment Method
Credit Card Number    
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card Address 2
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number