Application:  Utah State Chamber of Commerce
 

Name of Chamber______________________________________________________________________

Address______________________________________________________________________________

Telephone_________________________________________FAX________________________________

Web Site__________________________________________E-mail______________________________

Number of Members_____________________Population of City/Area____________________________

Investment Amount $______________________See Rate Schedule

Name of Paid CEO _______________________________________Title__________________________

Elected Officers:

          Name                                                                    Title/Position

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________
    

Membership Investment/Dues Schedule

1 to 100 Members          $25
100 to 250                      50
250 to 500                      75
500+                             125

Make checks payable to:

UTAH STATE CHAMBER OF COMMERCE
175 East 400 South, Suite 600
Salt Lake City, Utah 84111
801-328-5090

E-mail: info@utahstatechamber.org 
or chamberpresident@gmail.com

2005 Chairman:
Glen Cobb, Sandy Chamber