Thank you for your interest in joining the Eastern Collier Chamber of Commerce. Please complete the new member application below:

Member Application:

* Company Name:

* Phone:

* Email:

* Physical Address:

* City/State/Zip:

Country:

Mailing Address:

Same as physical address

City/State/Zip:

Country:

Business Category:

Employees:

Full-time: Part-time:

Comments/Questions:

Primary Contact Information:

* Name (First / Last):

/

* Phone:

* Email:

Contact Preference:

Email Phone

Address:

Same as Company Address

City/State/Zip:

Country:

Billing Contact Information:

Same as Primary Contact

* Name (First / Last):

/

* Phone:

* Email:

Contact Preference:

Email Phone

Address:

Same as Company Address

City/State/Zip:

Country:

Membership Package:

	Basic Member: $125.00
	Enhanced Member: $250.00
	Elite Member: $1,000.00
	Premier Member: $2,500.00
	Individual: $75.00
	Government: $100.00
	Not-for-profit: $110.00

Additional Opportunities:

We will contact you with additional information.

	Enhanced Web upgraded member section on website (included in Elite and higher memberships)
	Advertising Pak Online advertisements and hot deals (included in Elite or higher memberships)

Payment Option:

Bill me

Submit Application:

Enter the CAPTCHA words, then press the Submit Application button.

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Member Application:

Primary Contact Information:

Billing Contact Information: