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.

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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