To the Board of Directors:

Please enter my application for membership in the SEARCY CHAMBER OF COMMERCE, Inc. I pledge the sum of for membership, and agree to pay this amount of dues, to be collected annually, in advance.

It is understood that membership shall be for a minimum period of one year from the date of record and shall continue on the above basis until cancelled in writing to the Board of Directors, or by the transfer or removal of the subscriber from the vicinity of Searcy.

Business Name or Individual's Name:

Address:

E-mail Address:

Telephone: Fax:

Contact Person:

Title: