Member Application

Welcome and thank you for your interest in the River Region Chamber of Commerce serving the parishes of St. John, St. James and St. Charles.

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Step 2:

Additional Info

Business Description (200 char max) *

Please add your company description.

Business Keywords (enter a space between words)

Directory Category

Full-time Employees

Part-time Employees

Annual Investment *

Looks good!

Parish *

Looks good!

District

Reason for Joining *

Looks good!

Year Business Started *

Looks good!

Actual Business Start Date *

Looks good!

Type Work *

Looks good!

Referred By *

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Cell Phone

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Cell Phone

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password *

Please add your login password.

Step 5:

Comments/Questions

Payment Option

Bill Me

Please complete the Captcha

Back Next Submit Application Print Application

Printed courtesy of www.riverregionchamber.org/ – Contact the River Region Chamber of Commerce for more information.
390 Belle Terre Blvd., LaPlace, LA 70068 – (985) 359-9777 –