Greater Picayune Area Chamber of Commerce

Join the Chamber

Greater Picayune Area Chamber of Commerce
MEMBERSHIP APPLICATION

Company Name:
Primary Local Executive & Title:
Billing Address & Contact Name:
Business Address:
Phone:	Fax:
Email:	Web:
Primary Executive Email :
Business Category (Limit 3, see category list):
Number of local Full-Time Employees:	Number of Voting Members ($120 per voting member)
Names of Voting Members:
1.	2.
3.	4.
5.	6.
7.	8.

Please check an area of committee interest: Budget Committee Income & Development Committee Retail Promotions Committee Programs Committee
Recruited by (please provide name) : Ambassador Board Member GPACOC Staff Other
To help insure the future growth and prosperity of our area I hereby pledge the amount listed below as my Fair Share Investment in the Greater Picayune Area Chamber of Commerce. I understand that dues are payable in advance, and statements are automatically sent out each year for renewal of the membership which begins January 1st of each year.
Membership Fees $120 - Base Fee for Individual or business with 1-14 employees (one voting member) $240 - Business with 15-19 employees (two voting members) $360 - Business with 20-29 employees (three voting members) $480 - Business with 30-39 employees (four voting members) $600 - Business with 40-49 employees (five voting members) $720 - Business with 50-69 employees (six voting members) $840 - Business with 70-89 employees (seven voting members) $960 - Business with 90+ employees (eight voting members) Corporate Sponsorship $500 - Bronze $1000 - Silver $2500 - Gold $4000 - Platinum Non-voting memberships: $60 - Ministerial $60 - Senior Citizen $10 - Student
It is understood that this membership renews itself yearly unless written notice of resignation is received.
Name:
Title:

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