Member Application

Thank You for joining the Encinitas Chamber of Commerce!

For all General, Non-profit, and Hotel memberships fill out the application in entirety

For all Individual Level Memberships please note:
- Part 1: Enter your full NAME in the place of COMPANY NAME
- Part 2: Skip all non-required answers & input zero on the employee counts

Feel free to call with any questions you may have 760-753-6041

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

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

MySpace

Google

Instagram

yelp

Step 2:

Additional Info

Business Description (200 char max)

Business Keywords (enter a space between words)

Directory Category

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

What makes your business unique?

How many years have you been in business

What are your hours of operation?

Provide any and all categories that best represent your business operations. Let us know if the proper categories are not available for your business.

I am interested in my business co-hosting a Moonlight Mixer

I would like to volunteer for Chamber events or for a community events

I am interested in becoming an Ambassador of the Chamber

How did you hear about us? *

Looks good!

If you were referred by another Member, who was it?

What would you like to gain from your membership? (First Choice) *

Looks good!

What would you like to gain from your membership? (Second Choice)

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Cell Phone *

Please add your cell phone number.

Fax

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

State

Postal Code

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name

Last Name

Title

Phone

Cell Phone

Fax

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

State

Postal Code

Create Account

Password

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Create Account

Step 5:

Membership Package

Additional Options:

Payment Option

Contact

535 Encinitas Blvd, Suite 116 Encinitas, CA 92024

Phone: (760) 753-6041

Fax: (760) 753-6270

admin@encinitaschamber.com

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