Membership Form

Return to Membership Page

To complete form just print it out, complete, and mail to the "Return To" address noted - Thank you!

2006 Membership Remittance
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..Friends & Supporters
..Non-Profit Organization		 $25
$50

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Business Membership Dues Schedule:
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No. of Employees
..Home-based Business
..1 - 2
..3-10
..11 - 20
..21 - 30
..31 - 40
..41 - 50
..51 - 100
..101-plus		 Dues Range
$50
$100 - $200
$150 - $300
$225 - $400
$275 - $500
$325 - $600
$400 - $700
$600 - $900
$1100 - $1500

TOTAL:
 Contact Information
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Contact Person:
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Company:
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Location/Address:
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PO Box:
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City:
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Zip Code:

Phone
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fax
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e-mail
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website
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Signature.(date)

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Return form & payment to:.
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Dodgeville Area Chamber of Commerce
338 N. Iowa St.
Dodgeville, WI 53533