FORT WHITE AREA CHAMBER OF COMMERCE

877 SW ROBERTS AVENUE

FORT WHITE, FLORIDA 32038

MEMBERSHIP APPLICATION



INDIVIDUAL MEMBERSHIP:         $10 PER YEAR
NAME:  ________________________________________________________________________________
TELEPHONE:       ________________________    EMAIL:  _______________________________________
ADDRESS:            ________________________________________________________________________


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NON-PROFIT ORGANIZATION MEMBERSHIP:      $20 PER YEAR
ORGANIZATION NAME: ___________________________________________________________________
CONTACT NAME:             _____________________________________     TAX ID #:  __________________
TELEPHONE:       ________________________    EMAIL:  ________________________________________
ADDRESS:            ________________________________________________________________________
WEBSITE:  ______________________________________             FACEBOOK:  ______________________


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BUSINESS MEMBERSHIP:             $25 PER YEAR
BUSINESS NAME:             _________________________________________________________________
CONTACT NAME:             _____________________________________     TAX ID #:  _________________
TELEPHONE:       ________________________    EMAIL:  _______________________________________
ADDRESS:            _______________________________________________________________________
WEBSITE:  ______________________________________             FACEBOOK:  _____________________


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 ALL APPLICATIONS ARE SUBJECT TO THE APPROVAL OF THE CHAMBER BOARD OF DIRECTORS. 

MEMBERSHIP MAY BE RESCINDED WITHOUT REFUND AT ANY TIME IF THE BOARD DEEMS

MEMBERS’ ACTIONS ARE CONTRARY TO THE MISSION OF THE CHAMBER.

 SIGNATURE:  ___________________________________                               DATE:  _____________________

< Please contact BetsyThomason@gmail.com for a printable application. >