Name of Owner/Manager :

Type of Organization : Retail, Restaurant,Financial, Media, on-profit,Other please specify)

Address :

Mailing Address :

E-mail Address & or website :

Phone numbers :

Home
Work
Cell
Fax

It is understood that membership shall be for one full year, and shall continue on the above basis until cancellation notification is received by the Monahans Chamber of Commerce or by death, dissolution, or removal of subscriber from the vicinity of Monahans. Signature below makes application for membership in the Monahans Chamber of Commerce and for services received, agrees to pay annually the sum of $

TYPE OF MEMBERSHIP : Individual/ Home-based Business/ Business (employee #)/Financial Institution / Utilities

PAYABLE : AnnuallySemi-AnnuallyQuarterly

SIGNATURE :

(PAYMENT IN FULL OF ANNUAL DUES WILL RECEIVE A 10% DISCOUNT)