EVENT & SPONSORSHIP REGISTRATION
2024
Name
First Name
Last Name
Business Name
Business Name
Gender
Male
Female
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which race would you like to join?
30 Mile Ride
5K Run
1 Mile Walk
Registrations and Sponsorships
*
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Cheer Squad
Post Event Donation: Show your support for this new event and help propel the Panola County Chamber of Commerce forward! Includes a social media mention!
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Chamber Champion
Post Event Donation: Let's reach or exceed the Chambers Fundraising Goal! Social Media Shout Out. Event T-Shirt.
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Chamber Superstar
Post Event Donation: Special recognition of your business in our upcoming pocket guide. Event T-Shirt. Social Media Shout Out.
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Platinum Partner:
Upgrade your Membership to Platinum Partner. Social Media Shout-Out, Recognition in the upcoming pocket guide. Event T Shirt. 2 Tickets to the 2025 Banquet. Your business logo on the side of the Chamber. Platinum Partner Recognition on the website & member profile.
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Name
*
First Name
Last Name
Date Signed
-
Month
-
Day
Year
Date
Signature: By signing here you are agreeing that you have read and agree to the above rules and liability waiver.
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