2006 MEMBERSHIP APPLICATION

(please print)

(name of firm)

(address including box number)

(city - state - zip 8 digits)

(owner or point of contact)

(phone# and fax# and your email address if you have them)

(please list your web site if you have one)

Pana Chamber of Commerce
Pana City Hall
120 East Third Street
Pana, Illinois 62557
217-562-4240
fax 217 562-3823
email: panail@consolidated.net