Membership Form 2009

BELTON CHAMBER OF COMMERCE 512 Main-P.O. Box 350-Belton, MO 64012 (816) 331-2420 fax (816) 331-8736 e-mail: [email protected] website: BeltonMoChamber.com

2009 Membership Categories (Circle one. Part time employees count as 1/2 or two equals 1) (1) (2) (3) (4)

$75.00 Individual/ Non-Profit Club $125.00 Home Based Business $150.00 Business/Owner 1 Employees $200.00 2-6 Employees (#______Employees)

(5) $300.00 7-15 Employees (#________Employees) (6) $400.00 16-20 Employees (#________Employees) (7) $600.00 Financial Institutions, Schools, Manufacturing, Utilities, & Others with more than 20 Employees. Any voting member in good standing may add a spouse membership by paying an additional $25.00 fee. Spouse would also have full voting privileges.

ÄVolunteers are the key to a strong Chamber. New faces and talents are always welcome. Please circle the Committee number(s) in which you have a special interest. 1. Golf Committee 3. Membership Committee 2. Legislative 4. Community Awareness _________________________________________________________________________________________________________________

Name ____________________________________________Spouse’s Name_______________________________________ Business Name________________________________________________________________________________________ CEO OR Manager_____________________________________________________________________________________ Location Address______________________________________________________________________________________ Mailing Address_______________________________________________________________________________________ E-Mail Address________________________________ Web Page Address_______________________________________ Phone__________________________________________Fax___________________________________________________ Representative to be listed in Directory_________________________________________________ How would you like your business listed in the Membership Directory & Webpage? Paying by credit card?       We accept:    MasterCard___   Visa___    Discover___    Amount____________  Number_________________________________     Expiration Date_______________  Billing  Zip code ___________ 

ÄDINNER BILLING OPTION: $100.00 for 9 Meeting meals (does not include Christmas Dinner).Current Charge is $12.00 at the door.(Jan, Feb, Mar, April, May, Aug, Sept, Oct, Nov.) If you would like to be invoiced for each meal The cost will be $15.00. . 2009 Dinner Option. Please include the $100.00 with your Membership Dues. _____________________________________________________________________________________________________________

ÄThe Chamber sponsors a Golf Tournament; each member is encouraged to participate in this event

through monetary donation, prize donation, entries in the event, or working at the event. For Office Use Only: Date Received ___________Amount Received ____________Check No.________ Dues _________Spouse__________ Dinner Billing______ CF___ DIR___DECAL____MEMADD(S)____EMAIL____WEBSITE____ New Business Listing for Belton____ Reservation Listing_____ M2M Card & Listing ____Schedule of Events____ First Friday Coffee Schedule____ Letter______