Member Application

Thank you for your application for membership to the Hempstead Chamber of Commerce. We look forward to working with you.

Business Information

Company Name: *

Phone: *

Email: *

Business 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: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Sustaining: $500.00
Business-small: $50.00
1-24 employees Business-medium: $75.00
25-49 employees Business-large: $125.00
50+ employees Non-profit: $50.00
Non-profit corporation or 501C3. Individual: $30.00
Not owning a business but interest in the community. Senior Citizen: $15.00
Over 65 and not owning a business.

Payment Option:

Bill me Charge my credit or debit card

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