Vermont's North Country Chamber Membership Application Please enable JavaScript in your browser to complete this form.Business Name *Contact Name: *Phone Number:Email: *Mailing Address:City, State, ZIP:Website (if applicable):Current Membership Level *Individual Support Membership - $100Bronze Membership - $275Silver Membership - $500Gold Membership - $750Platinum Membership - $1000Desired Membership Level *Individual Support Membership - $100Broze Membership - $275Silver Membership - $500Gold Membership - $750Platinum Membership - $1000 Phone for Membership Reason for Upgrade *Preferred Start Date *Terms and Conditions *I agree to the terms and conditions of this membership upgrade.Submit