Copyright  © 2008 - 2009 Lathrop Chamber of Commerce

PO Box 313 - Lathrop, CA 95330

MEMBER REFRESHER FORM

Print Registration Form for faxing

Required to read registration form)

Please fill out the form to keep your membership information current and accurate. If you have questions

about your membership, or would like more information - please contact Joyce Howard.

Chamber Contact

Joyce Howard

209.629.2403

Secretary, Lathrop Chamber of Commerce

Company Name:

Contact Person:

Street Address:

City:

State:

Zip:

Mailing Address:

Email Address:

Member Since:

Phone Number:

FAX Number:

Date Business Established:

Number of Employees:

Name of Owner / Manager:

Title:

Address of Owner / Manager:

Description of Business:

Additional Information:

Do we have your authorization to publish your Companies Name and Phone Number, Business address

on our Chamber Website and Directory publication:

(example: 10/26/2008)

(example: 209-222-2222)

(example: 209-222-2233)

(example: 10/26/2008)

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