SCCC MEMBERSHIP APPLICATION
Business Name: _______________________________________________
Contact Person: _______________________________________________
Mail Address: _________________________________________________
Physical Address (if different): _______________________________________
City: _______________________
State: _________ Zip: ________________
Business Phone: _________________________
Fax: ___________________
Email: __________________________________________________
Web Site: ____________________________________________________
Number of Employees: _________________
Type of Organization (e.g.: Manufacturing, Wholesale, Retail, Service):
Description of Business: _________________________________________
_________________________________________
_________________________________________
The membership year is from January 1 thru December 31
Dues Schedule
Self Employed - ($35)
1
to 2 Employees - ($45)
3
to 10 Employees - ($60)
11
to 19 Employees - ($85)
20
or More Employees - ($110)
Individuals & Couples (non-business) - ($25)
To apply complete the application, then select and circle the appropriate membership category
Enclose
form with a check payable to SCCC and
mail to:
Scottsville
Community Chamber of Commerce
PO Box 11, Scottsville VA 14590
Tel
: (434) 286-6000 Fax : (434) 286-6000
You may copy and print this application for mailing.
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Scottsville, Virginia
Chamber of Commerce
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