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Thank you for your interest in the Crossroads Chamber. Please call our office at 219-769-8180 with any questions you may have regarding our membership application.

1Business

2Representatives

3Membership

Member Information:

Business Name(Required)

Year Established(Required)

Business Address(Required)

Street Address City State ZIP

Phone(Required)

Fax

Owner/President Name(Required)

First Name Last Name

Primary Representative(Required)

First Name Last Name

Primary Representative Email Address(Required)

Billing Address(Required)

If different than above

Street Address City State ZIP

I would prefer to receive my chamber information via:(Required)

U.S. Mail

Website(Required)

Payment Information:

Select Your Membership Level(Required)

Silver

Gold

Silver Membership(Required)

Gold Membership(Required)

Total

Would you like to learn more about our Corporate Partner Program?(Required)

Yes

Payment Method(Required)

Invoice

Credit Card

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

Join Today

Join Today

Member Information:

Representative Information: Please list

Category Information:

Payment Information:

Connect with Northwest Indiana's Business Community

Stay In
Touch

QUICK LINKS

Resources

Join Today

Join Today

Member Information:

Representative Information: Please list

Category Information:

Payment Information:

Connect with Northwest Indiana's Business Community

Stay InTouch

QUICK LINKS

Resources

Stay In
Touch