Member Application

Thanks for your interest in joining the Polk County, GA Chamber of Commerce.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

Recruited by:

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

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

1-10 Full Time Employees: $195.00
11-20 Full Time Employees: $225.00
21-40 Full Time Employees: $275.00
41-50 Full Time Employees: $350.00
Non-Profit Group (must have proof of 501(c) status): $110.00
Individual (no business affiliate): $125.00

Payment Option:

Bill me Charge my credit or debit card

Print Application

Printed courtesy of www.polkgeorgia.com – Contact the Polk County Chamber of Commerce for more information.
133 South Marble St., Rockmart, GA 30153 – 770-317-6380 – director@polkgeorgia.com