PLEASE PRINT THIS MEMBERSHIP
APPLICATION
FILL IT OUT & PROVIDE MEMBERSHIP DUES
RETURN TO:
Historic Wallace
Chamber of Commerce
10
River Street
Wallace,
Idaho 83873
Phone/Fax: 208-753-7151
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Business
Information NAME
(use company’s name if applicable): __________________________________ Number
of Employees: ______ Type
of Membership: Contact
Person: Phone#_________________________________ Fax#___________________________________ Email:__________________________________ Web Site:_______________________________ Mailing Address: _______________________________________ _______________________________________ Physical
Address:
_______________________________________
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