Membership Application
Date ______________________ Firm Name
________________________________________________________________________________________________
Contact Name ______________________________________________________________________________________________ Mailing Address ____________________________________________________________________________________________ Street Address ______________________________________________________________________________________________ Town, State, Zip ____________________________________________________________________________________________ Phone _____________________________________________________________________________________________________ Email ______________________________________________________________________________________________________ Website
___________________________________________________________________________________________________
Description of Principal Products/Services ______________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
Annual Investment Schedule Classification q Banks/Utilities
Full-time Employees Dues n/a ....................... $425
q Commercial/Industrial/Professional 1-4 ....................... $170 q 5-24 ...................... $195 q 25-49 ..................... $295 q 50-100 .................... $485 q 100-249 ................... $675 q 250+ .................... $2035 q Non-Profit/Civic Tax Exempt No ________________ .......... $40 Your membership investment in the Clinton Chamber of Commerce is not deductible as a charitable contribution for income tax purposes, but may be deductible as an ordinary and necessary business expense. Consult your tax professsional.
q VISA/MC/AMEX/Discover
Mail your completed application along with payment to: Clinton Chamber of Commerce 50 East Main Street Clinton CT 06413 For more information call: 860-669-3889 or email
[email protected] www.clintonct.com
q Check enclosed ___________
CC # ________________________________________________________________________________________________ Exp. ___________________ CVV ____________________________
