Member Application Congratulations and welcome to the Pataskala Area Chamber of Commerce. Filling out this application is the first step in growing your business! 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 * required Please add your company name. Leave Blank Phone * required Please add your company phone number. Website Email * required Please add a valid email. Physical Address Address line 1 * required Please add your address. Address line 2 Country * required Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria North Macedonia Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad & Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam world Yemen Please add your country. City * required Please add your City. State * required 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 * required 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 * required Please add your State. Postal Code * required Please add your Postal Code. Mailing Address Same as physical address Address line 1 * required Please add your address. Address line 2 Country * required Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria North Macedonia Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad & Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam world Yemen Please add your country. City * required Please add your City. State * required 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 * required 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 * required Please add your State. Postal Code * required Please add your Postal Code. Social Network Addresses LinkedIn Facebook Instagram Twitter YouTube Step 2: Additional Info Business Description (200 char max) * required Please add your company description. Directory Category * required Choose... Advertising & Media Agriculture, Fishing & Forestry Arts,Culture & Entertainment Automobile & Marine Business & Professional Services Commercial Real Estate Computers & Telecommunications Construction Equipment & Contractors Education Family, Community & Civic Organizations Finance & Insurance Government Health Care Home & Garden Individuals Legal Lodging & Travel Manufacturing, Production & Wholesale Personal Services & Care Pets & Veterinary Real Estate Religious Organizations Restaurants, Food & Beverages Shopping & Specialty Retail Sports & Recreation Storage Takeout/Curbside PU/Delivery/Drive Thru Transportation Please select a directory category. Full-time Employees * required Please add your number of full-time employees. Part-time Employees * required Please add your number of part-time employees. How did you hear about us? * required Looks good! Would you like a Membership Plaque? Answer Yes or No. (Must attend a meeting to receive.) * required Looks good! What is your tagline? Step 3: Primary Contact First Name * required Please add your first name. Last Name * required Please add your last name. Title Phone * required Please add your phone number. Cell Phone Email * required Please add a valid email. Contact Preference Email Phone Address Same as Address in Step 1 Address line 1 * required Please add your address. Address line 2 Country * required Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria North Macedonia Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad & Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam world Yemen Please add your country. City * required Please add your City. State * required 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 * required 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 * required Please add your State. Postal Code * required Please add your Postal Code. Create Account This Login is already in use Login * required Please add your login username. Password * required Please add your login password. Step 4: Billing Contact Same as Primary Contact First Name * required Please add your first name. Last Name * required Please add your last name. Title Phone * required Please add your phone number. Cell Phone Email * required Please add a valid email. Contact Preference Email Phone Address Same as Primary Contact Address Address line 1 * required Please add your address. Address line 2 Country * required Choose... Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bermuda Bhutan Bolivia Bosnia & Herzegovina Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo (DRC) Costa Rica Côte d’Ivoire Croatia Cuba Czechia Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Ghana Greece Greenland Guatemala Haiti Honduras Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Laos Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Malaysia Maldives Mali Malta Mexico Moldova Monaco Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria North Macedonia Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia Somalia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad & Tobago Tunisia Türkiye Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam world Yemen Please add your country. City * required Please add your City. State * required 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 * required 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 * required Please add your State. Postal Code * required Please add your Postal Code. Create Account This Login is already in use Login * required Please add your login username. Password * required Please add your login password. Step 5: Membership Package Please select a Membership Package Social Level $ 175 Enhanced Level $ 300 Star Level $ 750 Bronze Star Level $ 1,000 Silver Star Package $ 5,000 Gold Star Level $ 10,000 Comments/Questions Payment Option Bill Me Charge my credit or debit card Please complete the Captcha Back Next Submit Application Print Application