Member Application

Thank you for your interest in joining the Copperas Cove Chamber of Commerce. Please complete the online form below. If you have any questions or would like to schedule an appointment call Michelle Nicolaus at (254) 547-7571 or email president@copperascove.com. Your investment is a commitment to the sustained growth and prosperity of the Copperas Cove community as well as an investment in the future success of your own business.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

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: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter Instagram

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Non-Profit Organization: $100.00
Individual Business: $100.00
Small Business: $250.00
Regional Business: $500.00
Large Business: $750.00
Institutional Business: $1,000.00

Payment Option:

Bill me

Print Application