Member Application

Welcome, and thank you for your interest in joining the Bedford Area Chamber of Commerce! When you join, you're becoming part of a network that connects leaders, strengthens our local economy, and helps our region thrive. As a Chamber, we serve as a catalyst for business success, a convener of regional leadership, and a champion for a vibrant and resilient economy. If you have any questions, please call us at (540) 586-9401! Once your application is submitted, a member of our team will personally follow up to welcome you and answer any questions.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

Facebook Twitter You Tube Instagram LinkedIn

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

Facebook Twitter You Tube Instagram LinkedIn

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

Facebook Twitter You Tube Instagram LinkedIn

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Print Application