Date
Type of Membership Pick One Renewal Membership New Membership
Business/Organiztion Name:
Contact Person for Chamber: Number of Employees:
Business Address: Telephone:
Company Web Site: List on PACC Web Site? Pick One Yes No
E-Mail Address: (for Chamber use only) Link on PACC Website? Pick One Yes No
Type of Business/Organization Business Non-Profit Home Based Business Private School/Day Care/Child Care Government/Public School
Brief Description of Business (20 words or fewer):
Category(ies) under which you wish to be listed in Chamber Member Listings. Maximum of 3
I would like to work on the following PACC Committees: Directory Events Membership 5K Race
Submit and Pay
PACC IS A NON-PROFIT 501 (c) 6COMMUNITY ORGANIZATION OF WESTERN MONTGOMERY COUNTY BUSINESSES, INCLUDING BARNESVILLE, BEALLSVILLE, BOYDS, COMUS, DAWSONVILLE, DICKERSON, JERUSALEM, MARTINSBURG, SENACA, POOLESVILLE
