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2021 Indiantown Chamber of Commerce Membership Application
2021 Indiantown Chamber of Commerce Membership Application
Membership Application Form
Business Name
required
Principal Contact
required
Title
required
Street Address
required
Mailing Address
required
City
required
Phone
required
Fax
Email
required
Internet Web Address
required
Industry Catagory
required
Number of Emplyees
required
Annual Investment
required
Diamond Trustee - $2500
Gold Trustee - $1500
Silver Trustee - $1000
Business (16+ Employees) - $300.00
Business (11-15+ Employees) - $275.00
Business (6-10 + Employees) - $250.00
Business (1-5 + Employees)- $225.00
Non-Profit/Civic Organization - $200.00
Friends of the Chamber - $175.00
Payment Information
required
Diamond Trustee
Platinum Trustee
Gold Trustee
Silver Trustee
16+ Employees
11-15 Employees
6-10 Employees
1-5 Employees
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Billing Address Line 1
Billing Address Line 2
Billing City
Billing State
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AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Conneticut
DC - Washington, D.C.
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
AS - American Samoa
GU - Guam
MP - Northern Mariana Islands
PR - Puerto Rico
VI - Virgin Islands
FM - Federated States of Micronesia
MH - Marshall Islands
PW - Palau
AA - America
AE - Europe
AP - Pacific
Billing Zip
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Exp Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
Exp Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
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American Express:
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Palm City Chamber of Commerce COW PLOP BINGO
Date:
Sun, Feb 28, 2021, 1:00 PM to 6:00 PM
Category:
Member's Event
Bike to Work Day
Date:
All day Wed, Mar 3, 2021
Category:
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