Page 14 - Stone Ridge Event Center

MEMBERSHIP ENGAGEMENT OPPORTUNITIES Membership Application Payment Options

DeKalb Chamber Rep:___________________ Check____Credit Card____
Join a Chamber Council Company Details # of Employees: _______ DeKalb Chamber of Commerce
Please make checks payable to:
Company Name: ______________________________________
Economic Governmental Education & Membership ____________________________________________________ Two Decatur Town Center, 125 Clairemont
Avenue, Suite 235, Decatur, GA 30030
Federal ID#58-0218054
Development Affairs Workforce Engagement Company Rep: ________________________________________ Memo: Membership Application
Development Title: __________________________________ (Incl Salutation)

Company Address: _____________________________________ I, ____________________________________ (name on card)

Small Business Annual Golf ____________________________________________________ hereby authorize DeKalb Chamber of Commerce to charge my

Advisory Meeting Tournament APEX (Special Instructions or Mailing Code:) debit/credit card account in the amount of $__________ for

Council ____________________________________________________ ______________________________ Membership Level.

Billing Address: (if different from above)
____________________________________________________ Credit Card Payment Options (Check One)

Chamber WELD Young ____________________________________________________ _____Visa_____MasterCard_____AmEx_____Discover
Ambassador Professionals Website URL: _________________________________________ (CC#) _________ - _________ - _________- _________
Contact #1: ___________________________________________
(CVC#) _________ Exp Date _________ /_________
(Name of Main Contact Person)
Contact Number: ______________ Contact Fax: ______________ Name on Card ____________________________________
To join a Chamber council, call Kim Childs at 470.355.7812 or kchilds@dekalbchamber.org.
Email Address: ________________________________________ Billing Address ____________________________________

Contact #1: ___________________________________________ City _______________________ ST _______ Zip ________
(Name of Main Contact Person - Optional) Authorized Signaure _______________________________
Take advantage of Member Benefits Contact Number: ______________ Contact Fax: ______________
Your completion of this authorization form helps us to protect
that save you $$ Email Address: ________________________________________ you, our valued members from credit card fraud. All information
Company Listing entered on this form will be kept strictly confidential by
(select category from below): DeKalb Chamber of Commerce. For annual reoccurring payments/
monthly subscriptions, your signature authorizes DeKalb Chamber to debit
credit card on file for current membership rate at the time of renewal.
Members are listed in the online membership database, searchable by using
the categories and key words listed below: Member Referral _________________________________
Arts/Entertainment Business Services Construction (required for member to receive recognition for referral)
Consumer Services Education/ Employment Pay By Check (Please make checks payable to):

Non-Profit
Services

DeKalb Chamber of Commerce
7.5% 25% 10-60% Financial/Insurance Government Healthcare Attention: Member Services, Two Decatur Towne Center
125 Clairemont Avenue, Suite 235, Decatur, GA 30030
Mfg/Dist
Hospitality/Travel
Legal
Request Invoice* Annual Reoccurring Payment**
Marketing/Media Real Estate Restaurants/
Clubs Monthly Subscription Payment
*Invoice is due upon receipt.
Retail Technology Transp/Log **Recurring payment plan available for Partner Level
members at an additional cost of $200.
Utilities Other Other On receipt of payment a member of the Chamber will contact you to welcome
you to the Chamber and ensure that all information received is accurate.
Key Words: (Provide a minimum 3 key words)
1 ___________ 2 ___________ 3 ___________ Thank you for supporting the DeKalb Chamber of Commerce! Your upfront
commitment and payment helps the DeKalb Chamber of Commerce increase
time spent on delivering programs that support the business community and
4 ___________ 5 ___________ 6 ___________ lessen the amount of time spent on raising funds. Thanks to your support, we
can get down to the business of making DeKalb County the best community it
Health & Wellness Plan Thank you for your support and future partnership with the DeKalb can be.
Chamber of Commerce.