Member Application Step 1: Member Info Step 2: Additional Info Step 3: Primary Contact Step 4: Billing Contact Step 5: Membership Options Step 1: Member Info Company Name * Please add your company name. Leave Blank Phone * Please add your company phone number. Website Email * Please add a valid email. Physical Address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Mailing Address Same as physical address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Twitter Instagram YouTube Step 2: Additional Info Business Description (200 char max) Business Keywords (enter a space between words) Directory Category * Choose... Accountants and Tax Services Advertising Specialties Agriculture Air Duct System Cleaning Aircraft Charter-Rental & Leasing Airlines Airports Antiques Apartments Apparel/Industries/Consultants Appliances Architects & Architectural Illustrators/Planners Art Galleries/Graphic Arts Assisted Living Attorneys Attractions, Museums & Recreation Audiologists/Hearing Aid Specialists Audio-Visual-Eqpt & Production Automobile Parts-Mfg Rep Automobile Renting & Leasing Automobile Repairs & Service Automobile Transporters Automotive Banks, Financial Institutions and Credit Unions Beauty/Health/Wellness Bed & Breakfast Boat Dealers & Marine Supplies Book Dealers, Stores & Depositories Brewery Bridal & Tuxedo Builders-Developers-Management Building Materials Business & Management - Development & Consultants Business/Development Consultants Campground Car Wash Career Services Carpet & Rug Dealers/Cleaning Caterers Catering Cement,Sand,Gravel & Stone/Concrete Chambers Of Commerce Child Development & Day Care Chiropractors Churches Cleaners Clubs-Country & Tennis Collection Agencies Communications-Telecommunications and Telephone Computer Services Computers-Computer Products Concrete Condominiums Sales Consignment Shop Construction - Homebuilders, General Contractors, Developers Consulting Contractors and Suppliers - Electrical, Plumbing, HVAC, Mechanical Copiers Counseling Credit Unions Dance - Studios and Instruction Data Processing/Computer Services/Computers Dentists & Orthodontists Department Stores Displays Distribution and Warehouses Distributors Drug Stores/Pharmacies Electrical Equipment & Supplies Electricians Electronic Supplies & Company Embroidery Employment Agencies Engineers/Architects/Surveyors Environmental Products & Controls Event Venue/Planner Exports/Imports Fabric-Draperies Fences Financial & Investment Companies Fire Extinguisher Sales & Services Fitness Centers/Trainers Flooring Florists Food Service/Grocery Stores/Convenience Markets Full Service Real Estate Settlement/Title Ins. Agency Fund Raising Organizations Funeral Homes & Memorials Furniture Garden Centers & Nurseries Glass Government Hardware Head Start Child Development Health Maintenance Organizations Heating, Air Conditioning, Electrical- Distributors, Eqpt & Home Decorative Accessories Home Medical Equipment Hospitals Hotel Management Hotels/Motels/Bed & Breakfasts Housing Information Individuals Insurance Integrated Technologies Interior Decorators & Designers Investment Counselors Janitors, Equipment & Supplies Jewelers Laboratories Land Development/Investments & Brokers Landscaping/Lawn Maintenance Limousine Services Lumber Mailing Manufacturer Rep. Manufacturers and Processors Marketing Research & Marketing Companies Media Production Men's Clothing Metal Products Miscellaneous Modular Homes Monuments Mortgage Loans & Bankers Movie Theatre Moving & Storage Museums Newspapers Nursing Homes/Rehab/Skilled Nursing Office-Supplies, Equipment , Furniture & Repair Oil & Gas Operators & Marketing Optical, Optometrists, Opticians & Optical Labs Organizations Painting Contractors Paints-Manufacturing, Dealers & Contractors Paper Distributors Paving Contractors Paving Contractors Pest Control Services Pet Shop, Grooming & Kennels Photography/Studio Physical Therapy Physician & Health Care Placement Service Physicians & Surgeons Plants-Sales, Leasing, Maintenance Plumbing Plumbing HVAC & Electrical Plumbing HVAC & Electrical Portable on Demand Storage Printers, Publishers, Typesetters, Graphics & Embroidery Private Investigator Psychologists-Psychotherapists Radio Stations Real Estate Real Estate Appraisers Real Estate Developers & Investors Real Estate/Farms & Ranches Recycling Reducing & Weight Control Services Rentals-Equipment & Furniture Restaurants and Caterers Restaurants, Caterers, Conference Centers Retailers Retirement Complex Roofing sale of industrial products Sales-Industrial Products Salons - Hair, Nail, Spa, Tanning Savings & Loan Associations Schools, Colleges & Education Secretarial Services Security - Products, Systems, Burglar Alarms & Companies Service Stations Services Shoes Shopping Centers and Malls Shredding / Record Storage Services Signs Specialty Shops Sporting Goods & Toys/Wholesale Stocks & Bonds Brokers Surveyors Swimming Pool Contractors, Service, Equipment & Maintenance tanks and displays Telephone Communication-Equipment Television/Cable Televisions, Radios & Stereos Tire Dealers Title Insurance Tobacco Tool Designers, Parts & Distributors Tourist Attractions Towing & Recovery Transportation Trash Hauling-Commercial & Landfills Travel Agencies Tree Service, Spraying & Horticulture Trophies & Plaques Upholstery Utilities Veterinarians Web Designers Wholesalers Women's Clothing Please select a directory category. Full-time Employees * Please add your number of full-time employees. Part-time Employees * Please add your number of part-time employees. Referred by Please share a one sentence description that we can use to promote your business on the radio during Chamber Minute. * Looks good! Race Choose... American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Ethnicity Choose... Hispanic or Latino Not Hispanic or Latino Gender Do you consider yourself as a person with a disability? Choose... Yes No Veteran Status: Choose... No Military, Reserve, or National Guard Service Veteran Service-Disabled Veteran Member of the Reserve Active Duty Member of the National Guard Spouse of Military Member Business Ownership: What percentage of your business is male or female owned? Step 3: Primary Contact First Name * Please add your first name. Last Name * Please add your last name. Title * Please add your title. Phone * Please add your phone number. Cell Phone Fax Email * Please add a valid email. Contact Preference Email Phone Address Same as Address in Step 1 Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Twitter Instagram YouTube Create Account This Login is already in use Login * Please add your login username. Password * Please add your login password. Step 4: Billing Contact Same as Primary Contact First Name * Please add your first name. Last Name * Please add your last name. Title * Please add your title. Phone * Please add your phone number. Cell Phone Fax Email * Please add a valid email. Contact Preference Email Phone Address Same as Primary Contact Address Address line 1 * Please add your address. Address line 2 Country * Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bermuda Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Please add your country. City * Please add your City. State * Choose... Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Please add your State. State * Choose... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Please add your State. State * Please add your State. Postal Code * Please add your Postal Code. Social Network Addresses LinkedIn Facebook Twitter Instagram YouTube Create Account This Login is already in use Login * Please add your login username. Password * Please add your login password. Step 5: Membership Package Please select a Membership Package General Membership Dues based on the number of full-time employees located in Danville & Pittsylvania County. This package includes individuals not representing a business, farmers, not-for-profit organizations, and most government agencies. See fee schedule and enter fee here: Please enter your fee. Professional Dues based on the number of full-time employees located in Danville & Pittsylvania County. This package includes accountants, architects, attorneys, engineers, appraisers, surveyors, insurance, real estate, financial advisors, clinics, physicians, and physician groups. See fee schedule and enter fee here: Please enter your fee. Hotels/Motels/Bed & Breakfast/Apartments Dues based on number of beds or apartments See fee schedule and enter fee here: Please enter your fee. Banks/Savings & Loans/Credit Unions Dues are based on local deposits. See fee schedule and enter fee here: Please enter your fee. Non-Profit Organizations/501(c)3 Status Must be a 501(c)3 organization with $250,000 and less in annual revenue. See fee schedule and enter fee here: Please enter your fee. Home-Based Business Home-based businesses with no 'store front' and no more than one full-time employee. See fee schedule and enter fee here: Please enter your fee. Start-Up Business Applicable for start-up businesses within the first year of operation in our region who have five (5) or fewer full-time employees at the time of their membership application submission *Not applicable for chains or franchises, home-based businesses, or non-profit 501 (c) 3 organizations with $250,000 and less in annual revenue. See fee schedule and enter fee here: Please enter your fee. Retired Patrons One retired person See fee schedule and enter fee here: Please enter your fee. Additional Options: Additional Business Location $75 one time Only available in conjunction with a business membership – One additional representative included. Comments/Questions Payment Option Bill Me Please complete the Captcha Back Next Submit Application Print Application
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