Hart County Chamber of Commerce

MEMBERSHIP APPLICATION

Please complete the following and return it with your membership fee to the Hart County Chamber of Commerce at P.O. Box 793 , Hartwell , GA 3064.  Membership fees are paid annually. Your renewal date will be one-year from the month in which we receive your fee.

            Firm Name _______________________________________________________

              Location _________________________________________________________

              Mailing Address    __________________________________________________

               City ______________________________   State _______   Zip ______________

              Telephone __________________________   Fax _________________________

              Contact __________________________________________________________

              Title _____________________________________________________________

              Number of Employees - Full Time ______________   Part-Time _____________

              Membership Investment Fee Paid ____________________________________

              Signature __________________________________   Date _________________

              Description of Firm/Business (Please include products produced, hours open, etc.)

              _________________________________________________________________

              _________________________________________________________________

              _________________________________________________________________

              _________________________________________________________________

            Would you like to be linked to our web-site                 yes_____          no______

               Web address:   ________________________________________________________

               Email: ______________________________________________________________