KCC Membership Application

For annual membership in the Kodiak Chamber of Commerce
to be renewed automatically unless written notice
is given 30 days prior to the anniversary date.

For new member special promotions please contact
Community Relations Director

Firm Name or Associate Member Name:
Physical Address:
Mailing Address (if different from above):
Billing Address (if different from above):
Business Phone:
Fax Number:
E-Mail Address:
Home Page/Website:
Owner Name:
Key Local Contact/Voting Representative:
Please describe your business (ie, retail, service, commercial fishing, etc.):
Would you like information about group health insurance rates for Chamber business members? Yes No
Would you have a few hours a year to serve on any of our Chamber committees? Yes No
Please select the committee(s) you would be interested in serving on:
Signature:
Title:
Chamber Representative:
Date:
Membership Investment Schedule
Number of Full Time Employees and/or Equivalent Part Time Employees (Including Self in Self-Employed):
Choose a level of membership:
	(**Not eligible for business benefits, to vote or hold office.)

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KCC Membership Application