Application Form

*These fields are required to submit form.

Member Information

*Company:

*Street:

*City:

*State:

*Zip:

Web Site URL:

*Contact Name:

*Contact Phone:

Title:

Fax:

*E-Mail:

# of Employees:

Referred by:

Business Information

*Business Type:

*Description of Business:

(limit 80 characters)

*Reason(s) for Joining (Please select all that apply)

Networking	Educational Programs	Informational Resources
Political Advocacy	Increase Sales	Business News
Marketing/PR Opportunities	Special Events	Other

Investment Schedule

Elk Grove Chamber of Commerce Investment Schedule
[This investment schedule is correct as of January 2005
and is subject to change.]

Businesses by Employee Size
No. of Employees	Dues
1-5	$375
6-10	$400
11-20	$430
21-35	$460
36-50	$500
51-75	$560
76-100	$660
101-150	$730
151-300	$850
301-500	$1245
501-750	$1685
751-1000	$2270
1001-1250	$2570
1251-1500	$2985
Over 1500	$2985 + $4.00 per employee
*Financial Institutions*
By Asset Size	Dues
$1-100 MM	$927
$101-200 MM	$1400
$20 1MM+	$2100
Non-Profit (501C3)
Dues
$375

Membership Investment

Elk Grove Chamber of Commerce is a not-for-profit organization and is not tax supported. Your membership investment is tax deductible as a business expense.

*Membership Investment:

(see above)

*Form of Payment

Check Mailed Visa MasterCard Amex
Note: We will call the Company Contact for credit card information.

Contacts

Provide names and e-mail addresses for everyone listed below, so we may notify them of programs and services of particular interest to them.

Owner/President:

E-mail:

Sales Manager/Salespeople:

E-mail:

Marketing/Public Relations:

E-mail:

Human Resources/Personnel:

E-mail:

Accounting:

E-mail:

Governmental Affairs:

E-mail: