North Chicago Chamber of Commerce MEMBERSHIP APPLICATION APRIL 1, 2012 THRU MARCH 31, 2013


PLEASE SEND IN THE FOLLOWING APPLICATION WITH A CHECK MADE OUT TO THE North Chicago Chamber of Commerce


P.O. Box 554 North Chicago, IL 60064


W


COMPANY NAME: ADDRESS: CITY:


[ STATE:


TYPE OF BUSINESS OR ORGANIZATION: (Please check one) NUMBER OF EMPLOYEES:


] CONTACT INFORMATION: (L


Name: Title:


Phone: Fax: E-Mail:


Website: BRIEF STATEMENT ABOUT YOUR BUSINESS TO INCLUDE IN DIRECTORY: List information as you want it printed in a directory) ZIP:


AMOUNT DUE BASED ON NUMBER OF EMPLOYEES $ Numbe r o f Employees


1 - 10 1 1 - 50


5 1 - 125 12 6 - 200


20 1 Employees and over 30


Dues $75


$100 $175 $300 $500


northchicagochamber.org | 847-785-1912 | northchicagochamber@yahoo.com


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