Name: |
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Job Title: |
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Company: |
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Business Address: |
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Zip Code:
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Mailing Address: |
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Zip Code:
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Years in Business: |
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Number of Employees: |
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Phone Number: |
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E-mail Address: |
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Fax Number: |
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Website Address: |
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Job Description: |
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Spouse's Name: |
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Years Married: |
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Number of Children: |
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Education: |
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Organization Memberships: |
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Special Honorsor Awards: |
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Interests or Hobbies: |
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Referred By: |
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Signature of Applicant: |
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Date:
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| I am interested in becoming involved in the following committees: |
Business Development: |
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Governmental Affairs: |
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Newsletter: |
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Membership: |
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Fund Raising: |
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Meeting Arrangements:
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| Annual Dues: $150.00 |
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Non Profit / Friends of Chamber: $75.00 |
Please make check payable to:
West Tampa Chamber of Commerce
Return this Printed Application along with your signature to:
Membership Committee
West Tampa Chamber of Commerce
P.O. Box 4946, Tampa, Fl 33677 |
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