Membership Application

Company Information

Name

Address

City

State

Zip

Website

Company Description

Contact Information

Primary Contact Name

Title

Phone Number

( ) - *

Fax Number

( ) -

Email Address

Secondary Contact

Membership Category*

Lesbian, Gay, Bisexual, or Trans-owed Business (More than 50% of business is LGBT owned.)

Small Business Supporter (Annual revenue $8 million and not LGBT owned)

Corporate Supporter (Annual revenue $8 million + and LGBT owned)

Non-Profit

Company Survey

Year Founded

Business Category

Annual Revenue

Client Base (select all that apply)

Corporate

Consumer

Small Business

Non-Profit

Women Owned (50% or more)?

Yes

Minority Owned?

Yes

Does your company include sexual orientation in its Diversity Policy

Yes

Does your company offer Domestic Partner benefits?

Yes

How did your company hear about The Chamber?

Payment Information

0-9 Full-time Employees &

Non-Profits ($110)

10-49 Full-time Employees ($155)

50 or more Full-time Employees

($395)

Additional Listings

Add each $50 per listing. Every member company receives one listing on our website and our published directory that distributed throughout Chicago (unless requested to be unlisted). If your company has multiple locations and you may request multiple listings

Membership Total:

Credit Card Number:

Credit Card Type:

Expiration Date

/ *

Billing Zipcode:

CSV Code:

Our Membership Packet offers further membership information and a printable membership application. Download Membership Packet