Membership Application - Pagosa Springs and Archuleta County

Pagosa Springs Chamber of Commerce Membership Application

Directory Information (to be displayed online)
Organization Name *
Physical Address 1 *
Physical Address 2
City *
State *
Zip *
Organization Phone *
Organization Toll-Free Phone *
Organization Cell Phone
Organization Fax
Organization Website
Organization Email *
Organization Description
Provide a description about your business and/or services you provide (1000 characters for a basic membership - 1500 for an enhanced membership)
Driving Directions
Hours of Operation
(8 keywords for a basic membership - 20 for an enhanced)
Main Contact
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip *
Phone *
Email *
Billing Address (if different)
Mailing Address (if different)
Additional Information
Year business established:
Would you prefer your mailing or physical address on the website or both?
Please list other businesses you own:
User Name Requested:
Password Requested:
Referred by
How did you hear about us?
What is your reason for joining?
Please have someone contact me regarding
*Check all that apply
Business Resources
Community Involvement
Cost Savings Programs
(Insurance, Office Supplies, Worker's Compensation)
Economic Development
Government Relations
Membership Information
Membership Level: *

*Professional Associate: Representatives of a business who work as independent contractors, outside sales reps or other non-employee persons who represent a company.

*Individual Associate: An individual or family who wants to support the local business community. They are eligible for membership discounts but there is no advertising for this membership level.

Primary Directory Category *
Additional Directory Categories
  • Primary Directory listing is complimentary
  • Additional Directory listings are $50 each
**Hold CTRL on your keyboard to select multiple categories**
Number of Full Time Employees:  
Number of Part Time Employees:  
Enhanced Description ($150):
Includes logo and picture on the website listing, 1500 characters in business description and 20 keywords for better placement on the search engine.
Billing Preference *
Total: $ 

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Annual Dues
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Additional Categories Cost
Enhanced Membership Cost
Number of Rooms (Hotels and Motels):  
Credit Card Information

Secured Transaction This process uses the latest SSL security encryption.

Credit Card Type *
Credit Card Number * 
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number
Credit Card Email Address
Please click submit only one time.  The transaction may take several seconds.

If you have any questions or if you receive an error message, please contact the Pagosa Springs Area Chamber of Commerce at 970-264-2360 for assistance.