Member Application Business Information Company Name: * Leave Blank: Phone: * Website: Email: * Business Description (200 char max): * Directory Category: * --- Select Primary Category --- Accountants Advertising Aircraft Antiques & Collectibles Apartments Architects Artist Attractions Automotive Banks/Credit Unions Bar Tending Services Barbershop Beauty Salons Bowling Business Services Cable Television Carpet Cleaning Casinos Catering Chiropractors Churches Clothing Colleges/Universities Computers Construction Consumer Goods Cookie Bakery Copiers/Printers Counseling Credit Card Merchant Processing Dentists Department Stores DJ Services Dog Grooming & Boarding Education Electrical Contractors Employment Energy Savers Engineering Farm Supplies Fence Construction Financial Services & Advisors Food Vendor Frozen Yogurt Funeral Homes Garage Doors Government Graphic Design/Printing Grocery Stores Health & Fitness Hearing Aids Heating & Air Conditioning Home Improvement Hospice Services Hotels/Motels Human Resources HVAC Controls - Installation & Service Insulation Contractors Insurance Internet Investments Jewelry Laboratory Lawn & Landscaping Lawnmower Repair Legal Services Library Liquor Stores Manufacturing Massage Therapy Military Mortgage Companies Movie Theatres Music Nail Salons Newspapers Nutrition & Wellness Office Supplies Organizations Paint Pest Control Pet Supplies Pharmacy Phone Company Photography Physical/Occupational Therapy Physicians/Medical Picture Framing Plumbing Pool & Spas Power Washing Pre-Schools Promotional Products Publishing Purses/Hand Bags Radio/TV Real Estate Real Estate - Commercial Recreation Center Rental-Party Supplies & Equipment Rentals & Storage-Industrial/Commercial/Construction Restaurants/Specialty Foods Restoration Companies Retail-Specialty Retirement/Assisted Living Schools/Private Schools/Public Security Systems Senior Living Shipping/Mailing Skilled Nursing & Rehabilitation Skin Care/Cosmetics/Nutrition Sports Sports Tax Preparation Telecommmunications Title Companies Trash Hauling Travel Agencies Utilities Veterinary Clinics Vision Care Business Keywords (enter a space between words): Comments / Questions: Physical Address Line 1: * Line 2: City: * State: * Postal Code: * Country: * --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Mailing Address Same as physical address Line 1: * Line 2: City: * State: * Postal Code: * Country: * --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Social Networking: Facebook Twitter Instagram Primary Contact Information First Name: * Last Name: * Title: Phone: * Cell Phone: Fax: Email: * Contact Preference: Email Phone Login: * Password: * Billing Contact Information Same as Primary Contact First Name: * Last Name: * Title: Phone: * Cell Phone: Fax: Email: * Contact Preference: Email Phone Login: * Password: * Membership Options Membership Package: * Annual Chamber Membership - Paid in Full: $325.00 Derby Chamber of Commerce membership for one year. Annual Chamber Membership - Paid Monthly: $30.00 Derby Chamber of Commerce membership paid in $30 monthly installments with a credit/debit card or checking account. Additional Opportunities: We will contact you with additional information. New Resident Welcome Bag Insert : $175.00 Every new resident that moves to the City of Derby receives a Derby Chamber of Commerce welcome bag. This add-on will allow you to place any promotional item of your choice in each welcome bag for one year. This is a great way to market your business to approximately 1,000 new residents each year! Additional Location : $125.00 Additional locations may be added to an annual membership at a reduced rate of $125, allowing the marketing of other locations. Businesses with second locations or branch offices must share common ownership and business category. McConnell Action Group : $50.00 McConnell Action Group (MAG) is a community program that helps support men, women and families of McConnell Air Force Base. MAG membership gives you access to exclusive invitations to McConnell Air Force Base events, tours and ceremonies. Chamber Ambassador Group : $0.00 Becoming a Chamber Ambassador is an excellent way to market your business and network among other members. Your increased involvement helps the community connect a face to your business and provides you with added visibility. Chamber Ambassadors receive exclusive invitations to ribbon cuttings and occasional VIP events, are recognized on the Chamber's website and social media accounts and get a personalized Chamber magnetic name tag. Payment Option: Bill me Charge my credit or debit card Please scroll down to view the entire policy and then click Accept. Decline I have read and accept the privacy policy of Derby Chamber of Commerce. I grant Derby Chamber of Commerce permission to contact me regarding my account, news, updates, and offers. Please read and accept the privacy policy before continuing. Print Application