Application

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Organization Information (to be displayed online)

Organization Name

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Address 2

City

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Phone

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Main Contact

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First Name

Last Name

Address 1

Address 2

City

State

Zip

Title

Phone

Additional Contacts

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Contact 1

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Last Name

Title

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Contact 2

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Contact 3

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Contact 4

First Name

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Contact 5

First Name

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Contact 6

First Name

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First Name

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Contact 8

First Name

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Contact 9

First Name

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Contact 10

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Billing Address (if different)

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Mailing Address (if different)

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Additional Information

Referred By

How did you hear about us?

What is your reason for joining?

Is your business a certified...?

Woman Owned Business
Minority Owned Business
Veteran Owned Business

Membership Investment

Membership Type

Number of Full Time Employees

Number of Part Time Employees

Number of Realtors

Additional Locations ($225 ea)

Primary Directory Category

Additional Directory Categories

Second category will be subject to additional $150 fee

Company Description (No more than 250 characters)

Chamber Champion

Chamber Champions is an investment opportunity in the Chamber and an upgrade in membership that gives your business additional benefits.

Click here to view benefits

Become an Investor

Through economic partnership, leadership and government relations we help make Collier County the best place to live, work and play in America.

Click here to view investment opportunities

Annual Membership Investment

Additional Items

Additional Categories Cost

One-Time Application Fee

Total

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Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

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Membership Type

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Millions in Assets

Number of Rooms

Number of Seats

Tax

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

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Credit Card Type MastercardVisaDiscoverAmex

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
State
Zip
Phone
Credit Card Email Address

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Application