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KERNVILLE CHAMBER OF COMMERCE PO BOX 397 11447 Kernville Rd Kernville, CA 93238 760-376-2629 Fax 760-376-4371 Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it www.kernvillechamber.org 2011-2012 Membership July 1, 2011 – June 30, 2012
Service charge included Type of Membership: ____ New ____ Renew Date: __________________ ____ Business $100.00 Type of Business:____________________________________________ ____ Affiliate $50.00 Non-Profit -Individual ____ Retired $25.00 Seniors over age 60 ____ Exchange Membership-Board Approval only
Business / Organization / Individual Name: _____________________________________________ Owner_____________________________________________________________________________ Contact person_____________________________________________________________________ Physical address________________________________City_____________________Zip_________ Mailing address________________________________City_____________________Zip_________ Telephone:________________________Fax: ________________________Cell: _______________ Website:________________________________________________Email:_____________________ (please print clearly)
Are you interested in participating in any of THE FOLLOWING PROJECTS? Please check! ___Whiskey Flat Days ___Rodeo WFD ___ Whitewater Wednesday Are you interested in any of the following committees? Please check! ___ Events ___ Hospitality ___Grants ___Membership ___ Civic Issues ___ Finance We will send Chamber communications to you via email unless otherwise specified. Alternate method of communication:__________________________________________________
Referred by:______________________________________________________________________
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