Post Office Box 278 * Vilonia, AR 72173

Membership Information:

INDIVIDUAL ($25.00 Annually)

Name: ___________________________________________________________

BUSINESS ($50.00 Annually – Includes annual listing on www.vilonia.org)

Business Name: ___________________________________________________

Contact Name: ___________________________________________________

Contact Title:______________________________________________________

Business Type: ____________________________________________

TO BE COMPLETED BY ALL APPLICANTS:

Street Address: ____________________________________________________

City: ________________________ State: ________ Zip: ________________

Phone: _______________________ Fax: _____________________________

Email: ___________________________________________________________

Website Address: __________________________________________________

By signing below I understand that all membership applications and all website content linked to the

Vilonia Area Chamber of Commerce site (www.vilonia.org) are subject to board approval.

Applicant Signature:                                                                                Date:

________________________________________                                 _________________