Membership Application Form

Please complete and submit the request form below and a membership representative will respond to you. If you need immediate assistance, please contact the Chamber at 316-265-6334. Or if you would prefer, you can download the membership application by clicking here and fax it to our office at 316-264-9965.
If you are an existing member and if you've received your renewal notice but haven't returned it yet...What are you waiting for?
When you receive our reminder, please take a few minutes to renew...so that your membership and all the benefits that come with it continue uninterrupted.

1. Member Information Primary Contact

Membership Status *

New Member Renewal

Full Name *

Title *

Company Name *

Web Address *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone # *

Fax # *

Business email *

Services Offered *

Is your company Hispanic owned and operated? *

Yes No

Is your company women owned and operated? *

Yes No

2. Investment Amount

Number of Employees *

Membership Category *

3. Payment Method

Check Send Invoice Send W-9

Recruited by *

Corporate Partner 2nd Representative