Davie Cooper City Chamber of Commerce Logo
 
MEMBERSHIP APPLICATION 
Membership Application


No. of Employees: Date:
Company Name:
Address 1:
Address 2:
City:
State: Zip:
Telephone: ( )
Fax: ( )
E-Mail:
Web Site URL: http://
Representative(s):

Type of Business: 		use keywords; separate with commas

 

Membership Investment Schedule:
1-5 employees $  225.00   Utilities $  775.00
6-10 employees $  315.00   Developers (base) $  505.00
Over 10 $  415.00   Non-Profits:  
Over 25 $  515.00   Clubs & Organizations $  155.00
Over 50 $  615.00   Educational:  
Over 75 $  715.00   K-12, Vocational $  180.00
100-500 $  815.00   College/Universities $  405.00
Over 500 $1,005.00    

 

Membership Fees (please fill in the appropriate amounts):
Investment:     $ 
One time Administrative Fee:     $       25.00
Total (Investment + Administrative Fee):     $ 

Sponsor:

Name on Card:   
Payment Method Card Number Expiration Date
V-code:   
We take VISA and MasterCard

Please fill out this application completely and click the submit button below (once!) to send using our secure server:
    


Please only click once to submit your info. If you need additional information, please call the Chamber at 954.581.0790.

CLICK HERE TO OPEN PRINTABLE APPLICATION If you prefer, you may click the image to the left to open and print the PDF version of the Membership Application and mail it to us with your check.
Choose FILE > PRINT from the Acrobat menu to PRINT the application.

4185 Davie Road - Davie, FL 33314 USA • Ph (954) 581-0790 • Fax (954) 581-9684 • Email:
 
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