Membership Application

Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

State

Zip

Phone

Fax

Website

Main Contact

Copy from Organization-Information

First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

Add/Remove Contacts

Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Billing Address (if different)

Address 1

Address 2

City

State

Zip

Mailing Address (if different)

Address 1

Address 2

City

State

Zip

Additional Information

Membership Investment

Membership Type

Primary Directory Category

Additional Directory Categories

Secondary Directory Category - $25

Number of Full Time Employees

Number of Part Time Employees

Annual Membership Investment

Additional Categories Cost

Total

Credit Card Information

Copy from Organization Information

Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

By submitting this application, I/We agree to work with the Chamber to make our community a better place to work and live and certify that I/We will conduct my/our business in an honest and ethical manner to all patrons. Membership in the East Bay Chamber of Commerce enables all member companies, through their representatives to apply for active membership in any special group, council, project team, task force or other organization within the East Bay Chamber of Commerce structure. Acceptance of the request for membership in these organizations will be dependent upon full compliance with and proper qualifications as outlined in the rules and regulations as established for their operation. I/ We agree to adhere to and observe the Laws, Rules, and Regulations of organization and all Bylaws as adopted by the Board of Directors of the East Bay Chamber of Commerce. I/We further understand that membership in the East Bay Chamber of Commerce is subject to ratification and approval by the organization's Board of Directors.

The membership covered by this application shall be considered as renewed from year to year, on the anniversary month of the membership, unless notice is given in writing prior to the renewal date. East Bay Chamber of Commerce dues are not deductible as a charitable contribution, however may be deducted as a business expense.

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