SUNCOAST AFRICAN AMERICAN CHAMBER OF COMMERCE INC.
P.O. BOX 11276, TAMPA, FLORIDA 33680-1276

MEMBERSHIP APPLICATION
(PLEASE TYPE OR PRINT CLEARLY)
 
NAME: __________________________________________________________________

BUSINESS NAME: _________________________________________________________

PREFERRED MAILING ADDRESS: ______________________________________________

CITY: _____________________ STATE: ____________ ZIP CODE: _____________

NUMBER OF EMPLOYEES: ______ DAYS AND HOURS OF OPERATIONS: _________________

YOU ARE: _____ NEW _____ RENEWAL MEMBER.

TEL: HOME (     ) _____________________ OFFICE: (     ) __________________________

FAX: (     ) ______________________ EMAIL ADDRESS: ____________________________

DESCRIBE YOUR BUSINESS: __________________________________________________ 
MEMBERSHIP RATES (PLEASE CHECK ONE)

MEMBERSHIP:
 
_____ STUDENT - $15.00   _____ SR. CITIZEN - $25.00 _____ INDIVIDUAL - $75.00

_____ BUSINESS OWNER - $300.00               _____ NON-PROFIT ORG. - $200.00

_____ SOLE PROPRIETOR - $150.00              _____ LIFETIME MEMBERSHIP - $500.00
CORPORATE:

_____ 1-9 EMPLOYEES - $250.00                 _____ 10-19 EMPLOYEES - $300.00
 
_____ 20-49 EMPLOYEES - $350.00

_____ 50-99 EMPLOYEES - $450.00              _____ 100 + EMPLOYEES - $550.00
CORPORATE SPONSORS:

_____ BRONZE - $1,000.00                          _____ SILVER - $2,000.00

_____ CORPORATE PARTNERSHIP BOARD - $2,500 - $4,999

_____ TRUSTEE BOARD - $5,000 - $25,000
I AM MOST INTERESTED IN:

__ EDUCATION ___ LEGAL ISSUES __ PUBLIC RELATIONS __ BUSINESS EXPANSION

__ YOUTH DEVELOPMENT __ MEMBERSHIP RECRUITMENT __ OTHER (DESCRIBE)

_______________________________________________________________________________
MEMBERSHIP DUES ARE NOT REFUNDABLE

MAIL APPLICATION AND PAYMENT TO:
SUNCOAST AFRICAN AMERICAN CHAMBER OF COMMERCE INC.
P.O. BOX 11276
TAMPA, FL 33680-1276