Name of Business, Organization or Individual:

Membership Level: Business Non-Profit Individual

Contact Name:   Title:

Business Address:

City: State: Zip Code:

Mailing Address (If Different): 

City: State: Zip Code:

Telephone:   Fax : Cell:

eMail Address:  

Would you like your website linked from our web site:Yes No

If yes - web address:

NUMBER OF EMPLOYEES: Self Employed (1) 2-6   7-20  20 or More

(For membership fee amount, call the Chamber at 409-962-3631)

Describe the type of business and services you provide

Payment Choice: Quarterly Semi-Annually Annually

Upon submitting of this  on-line application, I, the above contact, agrees to pay the specified membership fee to the Groves Chamber of Commerce & Tourist Center until changed or cancelled by written notice to the Chamber office. I understand I will be billed by the Chamber office for the applicable fee.