Member Application

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1

Address line 2

Country

City

State

Postal Code

Step 2:

Additional Info

Directory Category

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

State

Postal Code

Create Account

Password *

Please add your login password.

Step 4:

Membership Package

Please select a Membership Package

Civic $ 145

Individuals, religious institutions and civic, fraternal and service organizations

Small Business $ 290

All businesses, profit and not for profit with 9 employees or less

Large Business $ 475

All businesses, profit and not for profit with 10 or more employees.

Comments/Questions

Payment Option

Charge my credit or debit card

Please complete the Captcha

I have read and accept the privacy policy of Greater Patchogue Chamber of Commerce, Inc.. I grant Greater Patchogue Chamber of Commerce, Inc. permission to contact me regarding my account, news, updates, and offers.

Please read and accept the privacy policy before continuing.

Back Next Submit Application Print Application

Retail

Eat & Drink

Professional services

Marketing

Art & Entertainment

All Categories

Featured Event

MoCA L.I. Art Exhibit | Resonance

MicroNet-Template

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Membership Package

Payment Option