Membership Application

Business Name*
Contact First Name *
Contact Last Name*
Street Address*
Mailing Address
Preferred Method of Communication
Number of Employees Full Time    Part Time
Business Category
(Please inquire about your appropriate category and optional
purchase of additional categories at $50 each)

Who is your customer?
What businesses would you like to meet?
Referred By
Date Joined
Please state your reason for joining the chamber:*

Membership Level

Membership Investment One time
processing fee
Trailblazer $2,600 Waived
Power Partner $1,400 Waived
Community Connector $775 Waived
Market Mover $575 $30
Business Builder $425 $30
President's Club Membership (additional fee) $200
Please include additional member information
(employee name - title - email)
Investment Level                    

Add a President's Club Membership     

Total                                       $

Billing Information

*ALL Credit Card fields below are required*
Credit Card Type
Credit Card Number              
Name On Card
Security Code
Valid Through
Credit Card Address 1
Credit Card Address 2
Credit Card City
Credit Card State
Credit Card Zip
Credit Card ZipExt
Credit Card Phone Number
Credit Card Country
Credit Card Email Address
* I understand that by providing the fax and/or email information
above for the business or organization represented in this application,
I am authorized to and hereby consent for us to receive faxes and/or
e-mails on behalf of the Bonita Springs Area Chamber of Commerce.
Membership investment is non-transferable and non-refundable.
Please click submit only one time.  The transaction may take several seconds.