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Fill in the form below and then click the submit button at the bottom of the page. Contact Person: Title: Company Name: Address: Bill To Address: (if different) City: State: --Select-- Outside US Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming -- Other US -- American Samoa Federated States Of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico US Virgin Islands -- US Military -- Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Zip: E-Mail: Web Site: (if available) Phone Number: Toll Free Phone: Fax Number: Description of Business: Membership Dues 1-25 Employees - $75.00/Year 26-100 Employees - $125.00/Year 101 Plus Employees - $200.00 Membership Type Active – Individual representing a business, industry or profession located in or doing business in the Middlefield Area. This person should be actively engaged in the day to day business activity of the member business. Associate – Individual who does not meet the above criteria but subscribes to the goals of the Middlefield Chamber of Commerce and desires to support our work through membership. Honary – Individual who has distinguished himself/herself by meritorious service to further the cause of this organization.