2013/2014 Chatsworth/Porter Ranch Chamber of Commerce Business Directory & Community Guide 2013/2014 | Page 82
81 Membership Application
Chatsworth Porter Ranch Chamber of Commerce
Membership Application
10038 Old Depot Plaza Rd., Chatsworth, CA 91311 • T: 818-341-2428 • F: 818-341-4930 • www.chatsworthchamber.com
Business Name_________________________________________________________________ Contact Person______________________________________________________
Member Business Street Address__________________________________________________ City____________________________________ State___________ZIP_________
Telephone____________________________________________________________________ Fax______________________________________________________________
E-Mail_______________________________________________________________________ Website__________________________________________________________
Recommended By (Optional)____________________________________________________ Participation Interests_______________________________________________
Check No.___________________________________________________________________ Bank_____________________________________________________________
Credit Card: o VISA
o MC
o Discover
o Amex
Credit Card Number_____________________________________________________________________________________________________________________________
Expiration____________________________________________________________________ CVV Code________________________________________________________
Billing Address__________________________________________________________________________________________________________________________________
Card Holder Signature____________________________________________________________________________________________________________________________
I/We hereby apply for membership in the Chamber, subject to approval of its Board of Directors, with annual initial Membership Dues* of:
o
$275 (1-5 Employees)
o
$500 (50-75 Employees)
o
$850 (300-499 Employees)
o
$300 (6-10 Employees)
o
$350 (11-25 Employees)
o
$425 (26-49 Employees)
o
$550 (76-100 Employees)
o
$650 (101-200 Employees)
o
$750 (201-299 Employees)
o
$1,000 (500+ Employees Plus $100 for each 100 employees above 500)
o
$150 (Non-Profit)
o
$100 (Individual Resident)
Plus one-time Application Fee* of $25.00 for new members.
Signature_______________________________________________________________________________________________________________________________________
Please copy and fax completed form to 818-341-4930
*Membership Dues and Application Fees are subject to change at any time without notice.