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New/Renewal Membership Application

Send dues to: The Perry County Chamber of Commerce, 121 South Main Street, New Lexington, Ohio 43764-1376.

Membership starts at the time dues are paid and runs until the end of the year in which the dues are paid unless otherwise stated.

Number of W-2 Forms plus owner Annual Membership Dues
1 – 2 $120.00
3 – 10 $150.00
11 – 25 $180.00
26 – 50 $210.00
51 – 100 $240.00
101 – up $270.00
Non-profit organization $120.00
Elected Officials $60.00
Individuals/Retirees $60.00
Platinum $1200.00

Please complete the following form, print and mail with your membership dues to the address shown above.

Company Name (required)

 Yes, this is a new membership. No, this is a membership renewal.

Company Description

Company Representative (required)

Additional Associates ($25 Per Additional, Includes Voting Rights) (required)

Your Email (required)

Company Website

Company Description

Phone Number

Fax Number

Subject

Your Message

Number of W-2 Forms

Total Amount Remitted