Micronet Template

Welcome to Brunswick County Chamber of Commerce Online Application. We thank you for your interest in partnering with us to help you succeed in Brunswick County. Please fill out the application and submit it through our online system and we will be in touch with you shortly. We encourage you to review our levels of membership to determine the package that best fits your business needs. https://brunswickcountychamber.org/tieredbenefits/

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:

LinkedIn Facebook twitter Pinterest

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook twitter Pinterest

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:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook twitter Pinterest

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Non-Profit Level - 501(c)3: $195.00
Professional Level: $295.00
Executive Level: $450.00
Leader Level: $750.00
Partner Level: $1,100.00

Payment Option:

Bill me Charge my credit or debit card

Print Application

Explore Our County

Quick Tip Videos

Calendar of Events

Member Benefits

Contact Us

Member Application

Mailing Address

Address

Address

Explore Our County

Quick Tip Videos

Calendar of Events

Member Benefits

Contact Us