Member Application

Thank you for your interest in the Dubuque Area Chamber of Commerce & Tourism! If you have questions regarding membership, please contact Damian Waid at 563.557.9200.

Business Information

Company Name: *

Phone: *

Website:

Email:

Business Description (600 char max):

Business Category: *

Employees: *

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State / Province: *

ZIP / Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State / Province: *

ZIP / Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password:

Address

Same as Company Address

Line 1: *

Line 2

City: *

State / Province: *

Zip / Postal Code: *

Country: *

Membership Options

Membership Package: *

Base Membership Fee: $292.00
Base fee includes 1-5 employees. If you have more than 5 employees, please contact Damian Waid for a fee schedule at 563.557.9200

Payment Option:

Charge my credit card

In the effort to fight spam, please provide the answer to the following question.

What is the sum of 7 plus 3?: *

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