| * Firm or Individual Name |
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| Primary Chamber Contact |
| * First Name |
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| * Last Name |
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| * Title |
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| * E-Mail |
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| Fax Number |
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| Business Location Information |
| * Location Address |
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| * Location City |
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| * Location State |
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| * Location Zip Code |
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| Mailing Location Information |
| Mailing Address |
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| Mailing City |
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| Mailing State |
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| Mailing Zip Code |
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| * Main Phone Number |
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| * Employees: |
FT
PT |
| Sponsor |
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| Business Categories (1st is free, additional $50 each) |
| * Business Category 1 |
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| Business Category 2 |
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| Business Category 3 |
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| * Brief description of business or service: |
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| Website Address |
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| Other Representative(s): (Number of representatives is related to dues amount and are indicated on the dues
schedule)
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| Other Representative(s) 1 |
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| Other Representative(s) 2 |
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| Other Representative(s) 3 |
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| * Please select the most important reason you are joining the Greater Las Cruces Chamber: |
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| I hereby apply for membership in the Greater Las Cruces Chamber of Commerce. The Chamber will contact you with the full amount of your annual investment. |
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| * Security Code: |
Please type in the letters you see in the above image. If you are having trouble with the current image please refresh this page. |
* = required field |
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