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Membership Application

Organization Information (to be displayed online)
Business Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Email *
Main Contact
First Name *
Middle Initial
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Additional Contacts
Billing Address (if different)
Address 1
Address 2
Additional Information
Referred by
Is your company one of the following?
  • Minority Owned
  • Woman Owned
  • Veteran Owned
  • Disadvantaged
  • Other (describe below)

Primary Directory Category *
Number of Full Time Employees:  
Number of Part Time Employees:  
Membership Investment
There are a number of different membership levels that offer a variety of benefits. Associate and non-profit memberships can be purchased by contacting the Membership Manager at 812.945.0266. Click here for a description of each membership level. ACH payment is available. Please click here to download the ACH forms.
Membership Type: *
Total: $ 
I agree to allow the Chamber to contact me and/or company representative(s) by fax, phone or e-mail.

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets Cost
Additional Categories Cost
Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)
Additional Directory Categories
  • Primary Directory listing is complimentary
  • Up to two additional Directory listings are complimentary
  • After two, additional Directory listings are $35 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Rooms (Accommodations):  
Number of Seats (Restaurants):  
Number of Associates (Realtors, Attorneys):  
Number of Locations ($35/add. location):  
Millions in Assets (Financial Institutions):  
Enhanced Membership ($50):
NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information
Credit Card Type *
Credit Card Number *        
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address
Please click submit only one time.  The transaction may take several seconds.