MEMBERSHIP UPDATE FORM

        Please provide your Membership Number: (4 digit number located on the label at the top of your letter)

        Please provide the following contact information:

Organization
Street Address
Address (cont.)
City
State
Zip
Work Phone
FAX
E-mail
Website

Please enter contact information for the KEY REPRESENTATIVES for your business/organization.

Representative #1:

Title #1:

Email #1

Contact Phone #1:

Representative #2:

Title #2

Email #2

Contact Phone #2

Representative #3:

Title #3

Email #3

Contact Phone #3

Please indicated your preferred Business Category:

Category #1: (For both the printed Directory and website Directory)

Category #2: (Optional 2nd choice for website Directory)

Category #3: (Optional 3rd choice for website Directory)

        Please provide the following billing contact information:

Name
Title
Street Address
Address (cont.)
City
State
Zip
Work Phone
E-mail

Please provide the number of  Employees:

Full Time

Part Time:

Submitted by:

Date: 

Kinston-Lenoir County Chamber of Commerce
301 North Queen St, Kinston, NC  28502
252-527-1131
 info@kinstonchamber.com