MEMBERSHIP APPLICATION

 

 

 

 STUDENT

 

    $55.00

INDIVIDUAL

  $150.00

BUSINESS  Less than 6  employees

  $250.00

BUSINESS From 6 to 10 employees

  $350.00

BUSINESS  More the 10 employees -

  $450.00

Chamber o Trade Association -
 

Per Agreement

 Large Corporation

 $$ 1000.00

Please provide the following contact information:

 

First Name
Last Name
Title-

Organization

Street Address

 
Address (cont.)
City

State/Province -

Zip/Postal Code
Country
Work Phone
FAX

E-mail
Website

 

Choose one of the following options:

    Type fee  $  

 Additional Information or request for special services

Credit Card Information                 

Type of Card
number
Expiration date
Name in the Card
Amount

Enter the date of ... :-- mm/dd/yy

Thank you for your application.  We will send you all your information and  registration  within 24 hours.