Successfully reported this slideshow.
Your SlideShare is downloading. ×

Business CEO Chamber of Commerce Membership Application

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Loading in …3
×

Check these out next

1 of 2 Ad
Advertisement

More Related Content

Advertisement
Advertisement

Business CEO Chamber of Commerce Membership Application

  1. 1. General Membership Chairman’s Club Membership Level: MEMBERSHIP APPLICATION Membership Campaign Contact: donna@gwinnettchamber.org Phone: 770.232.3000 | Fax: 770.232.8807 gwinnettchamber.org (Specify Other Social) Additional Contacts: Please attach and specify. *Cell phone numbers are for internal use only and will not be shared for public use. Organization Name: ____________________________________________________________________ Years In Business: _________ Public Telephone: ______________________ Fax: ______________________ FT Employees: ___________ PT Employees: __________ Physical Address: _________________________________________ City: ___________________ State: __________ Zip: ____________ Billing Address: __________________________________________ City: ___________________ State: __________ Zip: ____________ Industry/ Type of Business: ________________________________ Reason for Joining: ________________________________________ Twitter: _________________________________ Website: ___________________________ __________: _______________________ Primary Contact: _______________________________________________________ Title: ___________________________________ Direct Phone Number: _________________________ *Cell Phone: _________________________ Fax: __________________________ Contact Email Address: ________________________________________________ Office at Listed Address? Yes | No Secondary Contact: _____________________________________________________ Title: ___________________________________ Direct Phone Number: _________________________ *Cell Phone: _________________________ Fax: __________________________ Contact Email Address: ________________________________________________ Office at Listed Address? Yes | No Human Resources Contact: _______________________________________________ Title: ___________________________________ Direct Phone Number: _________________________ *Cell Phone: _________________________ Fax: __________________________ Contact Email Address: ________________________________________________ Office at Listed Address? Yes | No Billing Contact: _________________________________________________________ Title: ___________________________________ Direct Phone Number: _________________________ *Cell Phone: _________________________ Fax: __________________________ Contact Email Address: ________________________________________________ Office at Listed Address? Yes | No Marketing/ Sponsorship Contact: __________________________________________ Title: ___________________________________ Direct Phone Number: _________________________ *Cell Phone: _________________________ Fax: __________________________ Contact Email Address: ________________________________________________ Office at Listed Address? Yes | No Gwinnett Chamber of Commerce | 6500 Sugarloaf Parkway | Duluth, Georgia 30097 President/CEO: Nick Masino | Chairman of the Board: Tom Andersen Office Use Only: WebLink: A/D: R/D: S/C: ____________________ ____________________ ____________________ ____________________ Page 1 of 2 Volunteer: ________________________________________________
  2. 2. Networking Events Program Sponsorship Hosting an Event Chairman’s Club Speaking Prospect Catering an Event Marketing Networking Legal Structure & Assistance Social Media Minority Assistance Contracting & Procurement Leadership Access to Capital Other (Please Specify Below) Business Development Business Planning ____________________________________ NOTE: Membership dues will be billed one month prior to your anniversary date and payable upon receipt of invoice. Annual Dues: Circle Membership Type: Gen. Membership | Chairman’s Club $35 Administrative Fee: (One-time Only) Enhanced Web Listing: Business After Hours Showcase Booth: (Save 20% by reserving a booth now! Reg: $125) Month to Reserve: ______________________ Contact: _______________________ Program Sponsorship: Program to Sponsor: ____________________ Contact: ________________________ TOTAL: $____________________ $____________________ $____________________ $____________________ $____________________ $____________________ PLEASE CHECK ALL THAT APPLY: Applicant Signature: ____________________________________ Print Name: ____________________________ Date: ____________ Chamber Signature: _________________________________________________________ Date: _______________________________ Gwinnett Chamber of Commerce | 6500 Sugarloaf Parkway | Duluth, Georgia 30097 President/CEO: Nick Masino | Chairman of the Board: Tom Andersen Thank you for your interest in joining the Gwinnett Chamber. We look forward to serving you and your business. If you should need anything during the course of your membership, please contact Megan Lesko, Director, Membership Development. Email: mlesko@gwinnettchamber.org Phone: (770) 232-3000 Welcome to the Gwinnett Chamber of Commerce. To help maximize your membership investment and provide programs and benefits that fit your business needs, please complete the survey below: Membership Interest Survey WHICH BUSINESS TOPICS MOST INTEREST YOUR COMPANY? WHO IS THE BEST CONTACT PERSON TO DISCUSS THESE OPPORTUNITIES WITH FURTHER? Name: __________________________________________________ Phone: ________________________________________________ Title: ___________________________________________________ Email: ________________________________________________ Additional Notes: _______________________________________________________________________________________________ Page 2 of 2

×