Apply Now

Check any of the following promotional and involvement opportunities you may be interested in:
 Event Sponsorship Online Advertising Newsletter Advertising Committee Involvement

Company Name:

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Email:

Website:

Company Representative:

Title:

Additional Contact(s) - $30 Each:

Non-Profit?:
 Yes No

Number of full time employees:

Number of part time employees:

Business Description:

Date Business Established:

Sponsor:

Interested In:
 Health Insurance Energy Service Dental Insurance Telecommunication Service

Total Annual Investment:

Application Fee:
Add $20

Voluntary PAC (Not required - donation to political action committee is voluntary)
Add $50
 Yes No

Total Amount:

Please submit this form and send your check to:
NIAGARA USA CHAMBER 6311 Inducon Corporate Drive Sanborn, NY 14132