Member Application

Thank you for your interest! Please complete the following member information.

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Info

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

City *

Please add your City.

State *

Please add your MN.

Postal Code *

Please add your Postal Code.

Country *

Please add your country.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

City *

Please add your City.

State *

Please add your MN.

Postal Code *

Please add your Postal Code.

Country *

Please add your country.

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.

Referred By *

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Country *

Please add your country.

Create Account

Login *

Please add your login username.

Password *

Please add your login password.

Step 4:

Billing Information

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Email

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

City *

Please add your City.

State *

Please add your MN.

Postal Code *

Please add your Postal Code.

Country *

Please add your country.

Create Account

Password *

Please add your login password.

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Making Bullitt County, KY strong.

Bullitt County Chamber of Commerce
147 Combs Court
P.O. Box 1656
Shepherdsville, KY 40165

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