Membership Application

Are you interested in becoming a member? Please fill out the short form below and mail your check to:

Buckeye Lake Region Chamber of Commerce
P.O. Box 5
Buckeye Lake, Ohio 43008

Please note: Your submission confirmation might go to your SPAM folder so please check there if you want to keep your copy of your submission. Thank you!

Membership Application

Please check the appropriate box.*
- Fairfield, Perry, Licking County Business/ Professional/ Associate Member - $100.00
- *Outside Area Business or Professional Member - $175.00
* Outside area is defined as being outside of Fairfield, Perry and Licking Counties. Business members shall be those persons engaged in any business or professional activity. Associate members shall be those persons interested in the betterment of the Buckeye Lake area, but who are not directly engaged in any business or professional activity.
Date*
MM slash DD slash YYYY
Name*
First Last
Business Name*
Type of Business*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Alternate Phone
Email*
Enter Email Confirm Email
Website
Check Number on your check you will be sending for Membership*
This will allow us to match your membership application with your check. Please send your check to:
Buckeye Lake Region Chamber of Commerce
P.O. Box 5
Buckeye Lake, Ohio 43008