Member Application

Welcome and thank you for applying to be a member of the Winter Park & Fraser Chamber! Please fill out the information below. If you have any questions, please contact Membership Director, Maria Chavez at mchavez@playwinterpark.com.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website: *

Email: *

Business Description (200 char max):

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Email: *

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name:

Last Name:

Title:

Phone:

Cell Phone:

Email:

Contact Preference:

Email Phone

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Payment Option:

Bill me

I have read and accept the privacy policy of Winter Park-Fraser Chamber. I grant Winter Park-Fraser Chamber permission to contact me regarding my account, news, updates, and offers.

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