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Business Information

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Phone: *

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Employees:

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Comments / Questions:

Physical Address

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Postal Code: *

Country: *

Mailing Address

Same as physical address

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State: *

Postal Code: *

Country: *

Social Networking:

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Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

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Contact Preference:

Email Phone

Password: *

Social Networking:

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Address

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Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Associate Member: $75.00
Government Agencies Civic Organization Not For Profit Introductory Member: $125.00
This is for members who have never been in the Chamber before. Business and Others: $200.00
This is for a member who has already been a member of the Lodi & Lake Wisconsin Chamber.

Payment Option:

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Print Application

Contact the Chamber at (608) 592-4412 or i n f o @l o d i l a k e w i s c o n s i n .o r g. Our office is located on the second floor Associated Bank • 102 N. Main Street, Lodi, WI 53555