Vision Statement

To support the economic interests of members

through resources, programs and services.
104 N Main St.
PO Box 55
Fortville, IN

Phone: 317-485-0410
chamber@fortvillemccordsville.com

www.FortvilleMcCordsville.com

2012-2013 Membership Application

This application is for 2012-2013 Chamber membership with dues payable each year.
By signing below, you agree to abide by the terms of the Chambers by-laws and all
rules and regulations that the Chamber may from time to time adopt and amend.

2013 Board of Directors

Kevin Massa, President
Brent Archer, VP
John Senger, Sec.
Jill Martin, Treas.
Claude Robinson
Myron Rahn
Pastor Phil Edwards
Melissa Anderson
Steve Wilson

Annual Dues Schedule

Firm name:_________________________________________________
Street Address:______________________________________________

Full Membership (1-10 employees)

Full Membership (11-25 employees)
Full Membership (26-50 employees)
Full Membership (50+ employees)

$120.00
$168.00
$240.00
$600.00

_______
_______
_______
_______

($336.00 + $7.20 per each additional employee over 51 up to a maximum of $600)

Mailing Address:____________________________________________

Not for Profit Organizations

$60.00

_______

City/State/Zip:______________________________________________

One-Time New Member Application Fee

$50.00

_______

TOTAL:

Telephone:_____________________Fax:________________________
Website:___________________________________________________

$ _____________

Date:________ Applicant Signature:________________________

Category(s) of Business:______________________________________
No. of FTE Employees:_______

(FTE=Full-Time Equivalent)

General Meeting Luncheon Pricing

Lunch purchased at the door:

$10.00

Contact & Title:_____________________________________________

ADVANCE PURCHASE TICKET VOUCHERS

E-Mail:____________________________________________________

FIVE (5) LUNCH PACKAGE: $45.00x QTY:______=__________

GENERAL MEETING SCHEDULE

Meetings are held at NOON on the fourth Wednesday of
each month. Our meetings rotate between the locations of our
Chamber Members allowing them to showcase their
facilities and services.

TEN (10) LUNCH PACKAGE: $85.00 x QTY:______=________

TOTAL:

$__________

Please include a separate check with your Annual Dues

indicating Luncheon Vouchers