Member Application

Welcome and thank you for your interest in the Heritage Corridor Business Alliance, serving the communities of Lemont and Homer Glen. Please complete our membership application and do not hesitate to call the HCBA Office with any questions that you may have.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Directory Category: *

Employees:

Full-time Part-time

Comments / Questions:

Why did you join the Chamber?:

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: *

Social Networking:

LinkedIn Facebook

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

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: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Home-Based Business/Non-Profit: $99.00
Basic Level: $249.00
Diamond Level: $449.00
Gold Level: $749.00
Platinum Level: $1,449.00
Chairman of the Board: $3,000.00

Payment Option:

Charge my credit or debit card

Print Application

Member Application

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