Lebanon-Marion County
Chamber of Commerce
Membership Application
"Membership dues in the Chamber of Commerce may be tax
deductible as an ordinary and necessary business expense.
Dues paid to the
Chamber are not a charitable tax deduction for federal income tax purposes. The
Chamber is not a
charity, but serves as an advocate organization for area
business."
IRS (Reg. 11.162-6)
Firm Name: ______________________________________________________________________
Mailing Address: __________________________________________________________________
Street Address: ___________________________________________________________________
City: _____________________________State: _______ Zip Code: __________________________
Telephone: ___________________________________Fax: ________________________________
E-mail: ________________________________Web Address: ______________________________
Key Representatives
Name: _________________________________Title: _____________________________________
Name: _________________________________Title: _____________________________________
Type of Business: __________________________________________________________________
Annual Investment: ___________________________Number of Employees: ____________________
Full Time: ______________________________Part Time:__________________________________
Payment Attached ________________________Please Bill Me ______________________________
(Membership will be activated upon receipt of investment)
Signature: ________________________________________________Date: ____________________
Please complete and return today!