Chillicothe Ross Chamber of Commerce Leadership Application

MISSION STATEMENT:

The Chillicothe Ross Chamber of Commerce promotes economic and community development by providing services and addressing issues important to business.
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(740) 702-2722 | 45 E MAIN ST, CHILLICOTHE, OHIO

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Leadership Application
Please complete the information below and either submit online or print out and fax to the chamber at 702-2727. The deadline for the 2010-2011 program is August 30.

All fields marked with an * are required.

Name: *
Title:
Organization: *
Street Address: *
Address (cont.):
City: *
Zip Code: *
Work Phone: *
Home Phone: *
E-mail: *

How many years have you worked for this organization?

If different from above, how long have you worked for this organization in Ross County?

How did you learn of this program?

What do you hope to gain from the leadership program?

Who and where should the invoice for the $595 tuition be sent? Payment must be received before the orientation session. If you would like to set up a payment schedule, indicate in the space provided how you plan to pay.