Membership Application

Business Name
Contact First Name
Contact Last Name
Title
Street Address
Mailing Address
City
State
Zip
Phone
Fax
Website
Email
Preferred Method of Communication
Number of Employees Full Time    Part Time
Business Category
(Please inquire about your appropriate category and optional
purchase of additional categories at $50 each)

Referred By
Salesperson
Date Joined
Please state your reason for joining the chamber:

Membership Level

Membership Investment One time
processing fee
Tier III $2,000 Waived
Tier II $1,200 $30
Tier I $695 $30
Base Business Membership $395 $30
Charity or Individual Membership $295 $30
Additional Franchise $200 $30
President's Club Membership (additional fee)
$125 (less than 50 employees)    $350  (+51 employees)
Tier I or above: Brief description of business
(up to 100 words) for placement on the website.
Please include additional member information
(employee name - title - email)
Investment Level                    

Additional Franchise             

Add a President's Club Membership     

Total                                       $

Billing Information

Credit Card Type
Credit Card Number              
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card Address 2
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number
Credit Card Country
I understand that by providing the fax and/or email information
above for the business or organization represented in this application,
I am authorized to and hereby consent for us to receive faxes and/or
e-mails on behalf of the Bonita Springs Area Chamber of Commerce.
Membership investment is non-transferable and non-refundable.
Please click submit only one time.  The transaction may take several seconds.