305 A Neosho St Burlington, KS 66839

[email protected]

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Membership Application

Please correct the errors highlighted in red and resubmit.

Please complete the form before submitting.

* First Name

* Last Name

* Email

Business Name

* Street Address 1

Street Address 2

* City

* State

* Zip Code

Website

Phone Number

Upload your Business Logo (jpg or png file format)

* What category describes your business?

Advertising, Promotions, & Media
Agriculture, Fishing, Forestry
Arts & Crafts
Automotive & Aviation
Business & Professional Services
Community & Non-Profits
Construction & Contractors
Finance & Insurance
Government & Education
Health & Wellness
Home & Garden
Industrial & Manufacturing
Personal Services & Care
Pet Services
Real Estate & Moving
Restaurant, Food, & Beverages
Retiree
Shopping & Retail
Transportation
Travel & Lodging
Wedding, Meeting, & Venues

* Membership Levels

Basic Business Member - $250.00

Choose Quantity

Home-Based Business/Retiree Member - $150.00

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Non-Profit/School Member - $150.00

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Community Leader - $500.00

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Platinum Member - $850.00

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* Will your business accept Chamber Bucks?

No
Yes

Total Price: $0.00

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Contact

Coffey County Chamber of Commerce

305 A Neosho St
Burlington, KS 66839

Mon, Tue, Wed, Thu 8:00am- 5:00pm

Fri 8:00am- 3:00pm

[email protected]

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