Membership Application
Today's Date______________
Company Name: ___________________________________
Street Address:____________________________________
City:_______________________ State:_____ Zip:________
Phone Number: __________________
Web Site:_________________________________________
Mailing Address (if different):___________________________
City:_______________________ State:_____ Zip:________
Representative to Latino Chamber:
_________________________________________________
Representative Email Address:_________________________
Representative Title/Department:______________________
Latino Owned Business:____________ YES ___________ NO
Description of Business:______________________________
_________________________________________________
__________________________________________________
_________________________________________________
_________________________________________________
MEMBERSHIP DUES/INVESTMENT
Sponsor:___________________________________$500.00
Business Member:____________________________$200.00
Individual Member:___________________________$100.00
Full Time Student:_____________________________$50.00
GOLD: $5,000.00 SILVER: $2,500.00 BRONZE: $1,500.00
__________________________________________________
PAYMENT INFORMATION
Date:_______________
$___________________Check made payable to
Greater Conroe Latino Chamber
Mail to: Marisa Olivares Rummell
25223 Spring Ridge Dr.
Spring, TX 77386-1513 (281) 367-2138