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Tel: (847) 680-0750 Fax: (847) 680-0760 |
Membership Application Form |
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| Company Name: | |
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| Title: | |
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| State: | |
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| Phone: | |
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| Your Products/ Services: | |||
| Business Directory Classification(s): | Main Category: | ||
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| Number of Full-Time Employees: | Number of Part-Time Employees: | ||
| If a Bank, Number of Officers : | If Hotel/Motel/Apartment, # of Rooms: | ||
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Membership Level Desired: Regular Membership: Dues are renewed each year. Platinum Membership: Support the Chamber with double dues and receive a special name badge for events and bold membership listings in GLMV Community Guide, membership directory, website and other Chamber publications. Your name will also appear in each issue of the Chamber's newsletter and you'll receive a feature story. Pay By: Credit Card (VISA/Mastercard) Check |
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| Dues Amount: | ____________________________________________ |
| Credit Card Type: | ____________________________________________ |
| Credit Card Number: | ____________________________________________ |
| Expiration Date: | ____________________________________________ |
| CVV2 (3-digit security number, usually on the back of the card): | ____________________________________________ |
Comments? Questions? |
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