Tamarac Chamber Membership Application

Calendar of Events .................................... Special Events .................................... Membership .................................... Trustee Membership .................................... 2012 Board of Directors .................................... Advertising .................................... Join Now .................................... TamNet Referral Group .................................... Shop Chamber		TAMARAC CHAMBER MEMBERSHIP APPLICATION Click Here For Partnership Investment Schedule Please print this page, fill it out entirely and fax or mail it to us! Phone - 954.722.1520 Fax - 954.721.2725 7525 Pine Island Rd. Suite#103 • Tamarac, FL 33321 Business Name: ________________________________________________Date: _________________________________ Representative: _________________________________________________Title: ________________________________ Business Address: ___________________________________________________________________________________ ___________________________________________________________________________________________________ Phone: _______________________________________ Fax: __________________________________________________ Email: ________________________________________ Website: ____________________________________________ Service/Industry: (Detail)_______________________________________________________________________________ Number of Employees: ___________ Referred by: ________________________________________________________________________________________ Membership Fee: ________________________+ $35.00 (One time administration fee) = Total: $________________ Check Visa Master Card American Express Account #______________________________________________________Expiration Date:_______________________ Name: _____________________________________________________________________ Please print as name appears on card. Signature: __________________________________________________________________ Yes! I want information on Tamarac Chamber of Commerce news, activities and opportunities. My preferred method to receive this information is: Via Fax Via Email Both _____________________________________________ ________________________________________ Contact name Signature Membership fee includes one location and 2 representatives. Application Subject to board approval.