State Chamber/AIA Membership Application

Arkansas State Chamber of Commerce Membership Application
(For additional contacts, please submit this form and then complete it again.)

 
Company Name: 

Contact: 

 First Name:
Last Name:
            Title: 
Mailing Address: 
Address - Line 2: 
City:
 State: Zip:
Phone:
FAX: 
 xxx-xxx-xxxx
xxx-xxx-xxxx
E-mail: 
Type of Business: 
 NAICS #: Number of Arkansas Employees:
Recruited By: 
Associated Industries of Arkansas (AIA) is the industrial group of the State Chamber. An issue
may arise of greater importance to the manufacturing sector than to general business, so AIA
may pursue it. If your company’s NAICS code begins with a 2 or a 3, you will be identified as an
AIA member and receive a complimentary membership in the State Chamber as well.

If you are interested in serving on committees that deal with any of the following issues,
please check:
Committees: 
 Arkansas Small Business Council Health Unemployment Compensation
Education Tax Workers' Compensation
General Program: 
 Employees: Dues:
1-10               $300
11-25             $500
26-35             $750
36-50          $1,000
76-100        $1,500
51-75          $1,250
100-plus     $2,500
PINNACLE Program: 
 Step up today as a PINNACLE member and join others who support the State Chamber/AIA at
the highest levels.
$35,000 and up APEX Member
$25,000 SUMMIT Member
$10,000 PEAK Member
$5,000 CROWN Member
Dues: Payment Method Check to be sent Send invoice
Please call me to charge my: AMEX MasterCard Visa

PAC (Political Action Committee) Program
I want to contribute $ to the State Chamber PAC.
I want to contribute $ to the AIA PAC.
PACs: Payment Method Check to be sent Send invoice
Please call me to charge my: AMEX MasterCard Visa
Submit Application        Clear Form