847.498.5555 info@northbrookchamber.org

New Member Application

Member Application

To join the Northbrook Chamber, complete this simple application. Membership are in the name of the company. Dues are based on the number of employees at the location, starting at $275. Banks, utilities and charitable (501c3) organizations have a special dues rate. The Chamber accepts Visa, Mastercard or checks. Memberships will not be activated until payment is received and the application is approved. Please call us at (847)498-5555 or email Kathi@northbrookchamber.org if you have any questions.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (600 char max): *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Referred 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: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

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

Login:

Password:

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Print Application

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