Member

Step 1:

Member Info

Company Name * required

Please add your company name.

Phone * required

Please add your company phone number.

Website

Email * required

Please add a valid email.

Physical Address

Address line 1 * required

Please add your address.

Address line 2

Country * required

Please add your country.

City * required

Please add your City.

State * required

Please add your State.

Postal Code * required

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 * required

Please add your address.

Address line 2

Country * required

Please add your country.

City * required

Please add your City.

State * required

Please add your State.

Postal Code * required

Please add your Postal Code.

Step 2:

Additional Info

Directory Category * required

Please select a directory category.

Full-time Employees * required

Please add your number of full-time employees.

Part-time Employees * required

Please add your number of part-time employees.

Who referred you? * required

Looks good!

Step 3:

Primary Contact

First Name * required

Please add your first name.

Last Name * required

Please add your last name.

Title

Phone * required

Please add your phone number.

Cell Phone

Email * required

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

State

Postal Code

Create Account

Password * required

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name * required

Please add your first name.

Last Name * required

Please add your last name.

Title

Phone * required

Please add your phone number.

Cell Phone

Email * required

Please add a valid email.

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

State

Postal Code

Create Account

Password * required

Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

Stakeholder $ 8,000

Strengthen our regional economy

Life Sciences $ 6,000

Focus on Life Sciences

Leader $ 4,000

Representing your interest with governments.

Achiever $ 2,000

Support the development of leaders

Main Street $ 950

Promote your business as a destination.

Connector $ 400

New opportunities through relationships

Comments/Questions

Please complete the Captcha

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Create Account

Step 5:

Membership Package

Greater Rockville Chamber of Commerce