Application For Membership
Date:
Name of Owner/ President/Director:
Name of Business/Organization:
Street Address and/
or PO Box:
City:
State:
Zip:
Submit a short
paragraph defining
your business:
Phone (AC):
Fax (AC):
Alterante Phone (AC):
Email address:
Website address:
Annual Investment:
Number of Employees:
Yes, I/we would like to receive information on Health Insurance Plans available through the Latrobe Area Chamber of Commerce.
Proposed by:
LACC, 326 McKinley Avenue - Suite 102, Latrobe, PA 15650
Copyright©2005 • Latrobe Area Chamber of Commerce
326 McKinely Avenue • Suite 102 • Latrobe, PA 15650 • 724-537-2671
For information about membership benefits, go to www.ccsc.net
