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Business/Organization Name Date: 05/18/2008

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Contact Name Telephone Number Address Fax Number City, State Zip , Toll Free Number Website Address E-mail Address

What types of products or services do you provide? How long has your company been in business? How many rooms do you have? *Answer only if your business is a B&B, hotel or motel. How many campsites do you have? *Answer only if your business is a campground. What kinds of things do you think the Chamber should do for the community? Are you interested in working with a Chamber of Commerce Committee? Select One YES NO If Yes, which one? Select One Agriculture Committee Ambassador Committee Beautification Committee Economic Development Committee Retail & Business Promotions Committee Tourism Committee