Membership Application s4

Membership Application

Make checks payable to : British American Chamber of Commerce Broward County

Mailing Address : BACC SF, c/o: Roy Yates, 2800 N.E 41st Street,Lighthouse Point,Florida 33064 USA

FAX : 954 942 3588 Application Type: [ ] New Membership [ ] Renewal

Company Name: ______

Address: ______

City: ______State: ______Zip Code: ______

Contact Name: ______Title: ______

Telephone: ______Ext.: ______Fax: ______

Web Site: ______

Would you like this web site displayed as part of your profile on the BACC Broward County web site?

[ ] Yes, display this web site address. [ ] No, do not display this web site address.

E-mail: (this e-mail address will not be displayed on the web site)

______

Brief Business Description: ______

______

If you were referred by an existing BACC Broward County member, please tell us!

Member Company: ______

Contact Name: ______

Membership Level:

[ ] Trustee ($1000.00 US per year) [ ] Affiliate ($200.00 US per year)

[ ] Corporate ($500.00 US per year) [ ] Individual / Institutional ($150.00 US per year)

[ ] Small Business ($250.00 US per year)

Category: (select the one that best describes you or your company)

[ ] Professional Services (i.e. Medical, Law, Accounting, etc.)

[ ] Real Estate / Property Management

[ ] Travel (i.e. Airline, Cruise Line, Ground Transportation, Agency, etc.)

[ ] Technology & Telecommunications

[ ] Printing / Graphics / Publishing

[ ] Insurance / Risk Management / Security

[ ] Banking / Financial / Investment

[ ] Consumer Sales (i.e. Automotive Dealer, Retailer, etc.)

[ ] Shipping / Distribution / Logistics / Freight Forwarding

[ ] Manufacturing / Assembly / Distribution

[ ] Individual (use only if membership type is Individual or Student)

[ ] Miscellaneous / Other: ______

All membership applications are subject to approval by
the British American Chamber of Commerce Broward County Board of Directors.

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