Membership Application

MINERAL WELLS CHAMBER OF COMMERCE

APPLICATION FOR MEMBERSHIP

COMPANY NAME__________________________________________________

CONTACT PERSON________________________________________________

STREET ADDRESS_________________________________________________

MAILING ADDRESS________________________________________________

CITY___________________________________STATE_______ZIP__________

TYPE OF BUSINESS________________________________________________

PHONE(____)_____ - ______________ FAX(_____)_____ - _______________

E-MAIL___________________________WEB___________________________

NUMBER OF EMPLOYEES: 
                           Full-time________________ Part-time___________________

DATE BUSINESS WAS ESTABLISHED___________________________________

PAYMENT SCHEDULE: Annually Semi-Annually (Please circle one)

MAIN REPRESENTATIVE_____________________________________________

TITLE___________________________________________________________

SIGNATURE______________________________________________________

Please list any other representatives for your company and their titles:

_______________________________________________________________

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You will find a copy of membership benefits and a list of committees with a committee preference sheet. If you would like to be considered to serve on a committee, please fill out the preference sheet and return it to the Chamber office: P.O. Box 1408, Mineral Wells, TX 76067.

To be filled out by Chamber:

DATE JOINED____________________ ANNUAL DUES___________________

RECRUITED BY____________________             DATE___________________

Business Bio

PLEASE RETURN THIS BIO WITH YOUR NEW PACKET OR FAX TO 940-328-0850

BUSINESS BIO

PLEASE TELL US ABOUT YOU AND YOUR BUSINESS!!

WE WILL USE THIS INFORMATION TO HIGHLIGHT

YOU AND YOUR BUSINESS IN OUR NEWS LETTER

START DATE:___________________OWNERS___________________________

WHAT YOU DO:___________________________________________________

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ABOUT YOUR FAMILY:______________________________________________

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ANYTHING ELSE YOU WOULD LIKE TO HAVE PUBLISHED ABOUT YOU OR YOUR

BUSINESS:

_______________________________________________________________

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IF YOU HAVE QUESTIONS CONTACT NINFA HOLLY AT (940) 325-2557

Annual Investment Schedule

INDIVIDUAL MEMBERSHIPS
Individual or Family (one vote) $55.00
Seniors (over 62) $45.00

BUSINESS MEMBERSHIPS

1. Apartment, B&B, Hotel/Motel, Nursing Homes, Resort, Retirement Facility, RV $135 + 2.50 per unit

2. Automobile Dealers $175 base up to 5 employees (after 5, see schedule A)

3. Private Schools/Daycares $130

4. Licensed Professionals: Accountant, Attorney, Barber, Beauty Salon/Spa, Cosmetologist, Physicians, Insurance, Investment Company, Real Estate Agent, etc. $145 per principle company $75 per associate

5. Media & Publisher $155 base + $15 per employee

6. Taxing Authorities $570

7. Utilities $1140

8. All Other Businesses See schedule A

Non-Profit Membership
Churches and Non-Profit Organizations $55

SCHEDULE A
Employee Based Investments
Based on full-time employees (two part-time employees count as one full-time)

     1-5 employees $130

     6-10 employees $185

     11-25 employees $225

     26-50 employees $240

     51-75 employees $315

     76-99 employees $475

     100-199 employees $575

     200-299 employees $600

     300 employees & over $625

ONE OWNER/MULITPLE BUSINESS
With full investment of the primary or largest business, a multiple business discount will be given half the price of the standard dues investment.

ACTIVATION FEE
A one time $25 activation fee will be assessed upon application.

Mineral Wells Index 940-325-4465
First Financial Bank 940-327-5400
© 2007 Mineral Wells TX Chamber of Commerce All Rights Reserved.