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Membership Application

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Invoice
& Membership Application

          Membership at $100

  1. Fill out the  Application below and submit form.

  2. Print out Application for your records.

  3. Print out Application and mail with check  to address below. 

This is the only invoice you will receive.

Make Check payable to:
 Chamber101.com
18300 Arosa Rd
Tehachapi, CA  93561
USA
Tel:661 952 – 9686
E-mail: ceo@chamber101.com
URL Chamber101.com

Note:  
I understand that membership shall be for a minimum of one year from date received and shall continue on the above basis until cancelled by notice in writing or removed as a subscriber.

The membership is a dual membership, for both the Chamber and CEO until next annual billing date.                                                                                                                                   

                                                                                                                                            

Please provide the following contact information:

Billing Amount
First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Web site address

Please provide your account information:

User Name
Password
Confirm Password

 

BILLING
Purchase Order #
Account Name

Additional Comments


Please Print out this form for your records, before submitting.