Application

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Organization Information (to be displayed online)
Main Contact
Additional Contacts
Contact 1
Contact 2
Contact 3
Contact 4
Contact 5
Contact 6
Contact 7
Contact 8
Contact 9
Contact 10
Billing Address (if different)
Mailing Address (if different)
Additional Information

I understand that by providing my mailing address, email address, telephone number, and fax number, I consent to receive communications sent by or on behalf of The Harrisburg Regional Chamber & CREDC via regular mail, email , telephone, or fax.

Demographics (Check all that apply)
Membership Investment
 
Organizations with more than ten(10) employees may not choose the Community Connectors Membership Type. Please make an alternate selection.
  • *(Community Builders receive (2) additional)
  • *(Community Investors / Chairman’s Circle receive (3) additional)
  • Select additional directory categories below by holding the "CTRL" key
   
 

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NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.
Credit Card Information

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address
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