Application | Lakeland Chamber of Commerce | Lakeland, TN

Application

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Thank you for your interest in the Lakeland Chamber of Commerce. Dues are $135 for a business member, $50 for a non-profit, $50 for an individual. Please contact [email protected] for more information about membership or click here to download a PDF application form.

Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Website

Email

Main Contact

Copy from Organization-Information

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Email

Additional Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Add/Remove Contacts

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

How did you hear about us?

What is your reason for joining?

Membership Investment

Membership Type

Primary Directory Category

Number of Full Time Employees

Number of Part Time Employees

Number of Locations

Lakeland Shopper’s Card

Participation is optional and free for Chamber members. (Please note: this offer will be automatically renewed each year unless we are notified otherwise)

Please indicate the Lakeland Shopper’s Card special you would like to offer

Total

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

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

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

Additional Item 4

Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Additional Directory Categories

Select additional directory categories below by holding the "CTRL" key
Secondary categories may be subject to additional fees

Number of Rooms

Number of Seats

Number of Associates

Millions in Assets

Annual Membership Investment

Additional Items

Additional Categories Cost

One-Time Application Fee

Tax

Credit Card Information

Copy from Organization Information

Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

Please click submit only one time. The transaction may take several seconds.

Please select a membership type before submitting your application.

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