Membership Booklet
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Connecting you to the Greater Quad Cities Latino Community!<br />
<strong>Membership</strong> Application to the Greater Quad Cities Hispanic Chamber of Commerce<br />
Company _______________________________________________________________________________<br />
Street Address ___________________________________________________________________________<br />
City/State/Zip ____________________________________________________________________________<br />
Phone _________________Fax ________________Website _______________________________________<br />
Primary Contact & Title ____________________________________________________________________<br />
Direct Phone/E-mail _______________________________________________________________________<br />
Secondary Contact & Title __________________________________________________________________<br />
Direct Phone/E-mail _______________________________________________________________________<br />
Human Resources Contact, Title(s), Direct Phone & E-mail(s):______________________________________<br />
________________________________________________________________________________________<br />
Additional Representative(s), Title(s), Direct Phone & E-mail(s):____________________________________<br />
________________________________________________________________________________________<br />
Number of Full-Time Employees _______________Number of Part-Time Employees ___________________<br />
Business Categories________________________________________________________________________<br />
Date Company Founded __________________Date Joined ________________<br />
Chamber member that referred you ______________________________________________________<br />
Billing Address (if different than above)________________________________________________________<br />
The undersigned hereby makes application for membership in the Greater Quad Cities Hispanic Chamber of<br />
Commerce and, in consideration of this application being accepted, agrees to pay the membership fee of<br />
___________________ per annum. It is understood and agreed that this membership shall be continuous each<br />
year and that resignation will be made by written notice to the Board of Directors.<br />
Signed __________________________________________ Date__________________________________<br />
<strong>Membership</strong> Fee___________________Check enclosed ( ) Cash enclosed ( ) Invoice ( )<br />
Office use only<br />
Chamber Staff____________________________ Date __________________Invoice___________Email_____________Pack_______________<br />
511 17th Street, Moline, IL 61265 (309)797-8650 FAX (309)797-8655 info@gqchcc.com www.gqchcc.com
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