Page 70 - Bronx Chamber of Commerce - 2019 Business Directory & Resource Guide

THE BRONX CHAMBER OF COMMERCE
“The Network for Business Success”
1200 Waters Place, Suite 106, Bronx, NY 10461 Office: (718) 828-3900 Fax: (718) 409-3748 Website: www.bronxchamber.org
Joseph Kelleher, Chairman
Lisa Sorin, President
MEMBERSHIP APPLICATION
CLASSIFICATION & FEES
Please select your business classification and return with payment plus $100 application fee
_____ CHAIRMAN’S CIRCLE: $2,500
_____ PRESIDENT’S CIRCLE: $1,500
_____ SILVER BUSINESS MEMBERSHIP: $700 (First year w/ new membership $500) _____ BRONZE BUSINESS MEMBERSHIP: $350
_____ NON-PROFIT MEMBERSHIP: $300
_____ YOUNG PROFESSIONAL ENTREPRENEURS: $200 (for first year)
CORPORATE SPONSORSHIPS AVAILABLE / CALL FOR INFORMATION
Company/Organization: Primary Contact (owner): Address:
Phone:
Business Category:
City:
___ Title: State:
E-mail:
__ Zip:
__
__ Fax:
CREDIT CARDS ACCEPTED
Name on Card:________________________________________________________
Billing Address for Credit Card Payment:_____________________________________________________
City, State:______________________________ Zip:___________ Today’s Date:__________ Card #:______________________________________ *CVN:___________ Expiration Date:________
CVN is the last three or four digits on the back of the card.
Signature:_______________________________________________