Midland Valley Area Chamber Of Commerce
P.O. Box 310
Langley,SC 29834-0310
Office Phone: (803) 593-3030
Fax: (803) 593-0085
Membership Application
Organization Name:____________________________________________________________
Contact Name:________________________________________________________________
Address:______________________________________________________________________
City_______________________________________State_____________Zipcode__________
Phone:_________________________________Fax:__________________________________
Email:________________________________________________________________________
Type of Business:______________________________________________________________
Type of Membership ( Check One )
____Retired Senior Citizen 60 & Older-------------------------------------------------------------$10.00ea.
____Individual------------------------------------------------------------------------------------------------------$60.00
____Church/Civic/School--------------------------------------------------------------------------------------$60.00
____Small Business----------------------------------------------------------------------------------------------$85.00
____Commercial-------------------------------------------------------------------------------------------------$125.00
____Industrial------------------------------------------------------------------------------------------------------$215.00
____Other / ( Educational Institutions, Governmental Agencies, Professional )--$125.00
____Check Enclosed _____Please Bill
Name/s of Representatives
Please List Representatives To Recieve The News Letter First
______________________________________________________________________________
Signature_______________________________________________Date___________________
Sponsor ( If New Member ) ______________________________________________________
Note: Membership Expires On December 31st
