Membership Application

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Name: ______________________________Title: _______________________________

Company: _______________________________________________________________

Address: ______________________________City:______________________________

Type of Business: ________________________Number of Employees:______________

Business Interest in USA/Africa: _____________________________________________

Contact Person: _____________ Phone #: ____-____-______ Fax #: _____-____-______

Email: ___________________________ Referred By: ___________________________

Please Check a Membership Category

___ Student $50

___ Individual $100

___ Small Business $150

 

Corporate

___ Silver $500

___ Gold $1,000

___ Platinum $5,000

___ Life $10,000

 

Please Check Your Choice of Committee

___ Strategic Planning ___ Public Relations

___ Finance ___ Trade and Investment

___ Education ___ Membership

___ Research and Documentation ___ Community Development

___Other: __________________________

Please Check Your Method of Payment


___ Enclosed is my Check for the amount of $___________.

*Make your check or money order payable to the African Chamber of Commerce. Membership privileges are available to members only and are not transferable. I agree to abide by the rules and regulations of the African Chamber of Commerce of Texas, Inc. and will hereby pay my dues on a timely basis, otherwise this may result in suspension of membership.

Signature: __________________________________ Date: ___________________

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