2011-12  WOLFFORTH AREA CHAMBER OF COMMERCE & AGRICULTURE

 Name/Business Name_________________________________________________

 Business Contact Name_______________________________________________

 Mailing Address_____________________________________________________

 City _________________ State ___________ Zip _____________

 Home Phone ______________            Work Phone _______________________

 Fax _____________________             Mobile Phone ______________________

 E-mail address _______________________________________________

 BUSINESS MEMBERS, please complete the following, for listing on Chamber web site:

 Year business opened __________________ Location____________________________

 Owners/Managers_________________________________________________________

 Operating Hours_________________________ URL/web address:__________________

 Describe your products or services:___________________________________________

 ________________________________________________________________________

 Membership Level (please check one):

 _________ $75.00 Business

 _________ $50.00 Family or Individual

 _________ $25.00 Non-Profit Organization 

PLEASE RETURN THIS FORM, WITH YOUR CHECK OR MONEY ORDER, TO WOLFFORTH AREA CHAMBER OF COMMERCE & AGRICULTURE, P.O. BOX 35, WOLFFORTH, TX  79382