Membership Application $100   DATE: ___/___/200__ CONTACT NAME/OWNER: __________________________________________ POSITION/TITLE: ________________________ (Circle One) - Mr.    Mrs.    Ms. BUSINESS NAME: __________________________________________________ TYPE OF BUSINESS: _______________________ YEARS IN BUSINESS: ____ ADDRESS: _________________________________________________________ ___________________________________________________________________ MAILING ADDRESS (if different): _____________________________________ ___________________________________________________________________ PHONE: (____)_____-________      FAX: (____)_____-________ E-MAIL: ___________________@______________________________________ WEB SITE URL (if any): _____________________________________________ The Mattituck Chamber of Commerce web page is www.mattituckchamber.org. As a Chamber member, your business will be listed on the web page and annually on the Membership List distributed to the North Fork Promotion Council tourist booths. Message you'd like to appear on Chamber web page: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Mail completed application with your $100 check payable to the Mattituck Chamber of Commerce to: PO Box 1056, Mattituck, NY 11952 For any questions, please contact: info@mattituckchamber.org Chamber dues may be deductible to the extent allowed by law.