2011-12 Buffalo Grove Community Guide - Communities

28
CHAMBER OF COMMERCE MEMBERSHIP
Date of Application
Company Name
Address
City State Zip
Phone Fax
E-mail Address Publish Do Not Publish
Web Site Address
Contact for Chamber Title
Your Business Category/Type
Committee Interests
Provide a brief description of your business.
APPLICATION FOR MEMBERSHIP
We are required by law to inform you that, for income tax purposes
your membership dues are a necessary and ordinary business expense,
not a charitable contribution. Please note that all memberships are
valid through 12/31/11 and to be renewed on January 1, 2012.
bu f f a l o Gr o v e ar e a Ch a m b e r o f Co m m e r C e
me m b e r s h i P aP P l i C a T i o n
How (or from whom) did you hear about the Buffalo Grove
Area Chamber?
I give permission to the Chamber to e-mail and/or fax
information to my company.
Signature
Investment Dues Schedule
(Please note: Investments are prorated as
of the first day of the current month.)
Number of Employees* Annual Investment
O 1-5 $195
O 6-10 $245
O 11-25 $290
O 26-50 $375
O 51-100 $455
O 101-250 $525
O 250 + $710
O Charitable orgs, schools, worship $140
O Governmental $195
*2 part-time employees equal 1 full-time
Dues Investment $
Gold Membership (Optional)
Total $
_____Credit Card _____Check Enclosed
Visa MC Discover AmEx Exp.
# CID#
Buffalo Grove Area Chamber of Commerce
EIN: 36-2834462
P.O. Box 7124, Buffalo Grove, IL 60089
(847) 541-7799 Fax—(847) 541-7819
E-mail: info@bgacc.org
Website: www.buffalogrovechamber.org
Buffalo Grove Chamber of Commerce, 50 1/2 Raupp Blvd., (847) 541-7799, www.buffalogrovechamber.org