MD-BAL-CD-09 Body.qxp:MD-BAL-CD-09 Body.qxp
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Chesapeake Gateway Chamber of Commerce
Membership
investment
application
Company Name: ___________________________________________________________________ Company Representative: __________________________________________________________ Business (Yellow Page) Classification: _________________________________________________ Street or Mailing Address: ___________________________________________________________ City: _____________________________________ State: ________ Zip +4: __________________ Business Location (if different): _______________________________________________________ City: _____________________________________ State: ________ Zip +4: __________________ Phone: _________________________________ Fax: ____________________________________ Email: ___________________________________________________________________________ Website: ________________________________________________________________________ Sponsor: ________________________________________ Number of employees:______________ Membership Investment: ___ 1 –15 Employees……………..$225.00 ___ 31-100 Employees…………...$300.00 ___ Non-Profit Organizations……$125.00
___ 16-30 Employees…………….$250.00 ___ Over 100 Employees…………$400.00
Please Note Method of Payment: ____Check Enclosed ____Bill my company Charge to my: Visa____; MasterCard____; Discover____; or American Express_____ Account number: __________________________________________ Expiration Date: ___________ Name as it appears on Card: _________________________________________________________ Address where credit card statement is received: _______________________________________________________________ Zip Code: __________ Signature: __________________________________________________________________________ 405 Williams Court, Suite 108; Baltimore, MD 21220 Phone: 443-317-8763 Fax: 443-317-8772 Email: info@emrchamber.org Website: www.emrchamber.org 4
Chesapeake Gateway Chamber of Commerce