Livingston Chamber Renewal or New Membership Form

Business Name	Address
Contact Name	City
Type of Business	State
	Zip

Number of Employees		Annual Membership Dues	Phone:
1-10		$150.00	Fax:
11-25		$250.00	E-mail:
26-50		$350.00	Website:
50+		$500.00
Civic Membership		$100.00

____   I want to pay the optional one time fee for networking events for one year at $100.00.  (Includes 10 Networking Breakfasts and 4 Business Card Exchanges valued at $140.00.

Please, Make Check Payable to: Livingston Area Chamber of Commerce   Return copy of this form and payment to:   Livingston Area Chamber of Commerce   25 South Livingston Ave., 2nd Floor, Suite E  Livingston, NJ 07039-0595 Or Circle One   Visa     MasterCard        Amex       Amount $______     Card # ___________________________  Exp. Date ________   Billing Zip Code______