CCMBA MEMBERSHIP REGISTRATION

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You may also download the application and send to P.O. Box 1015 Huntingtown, MD 20639

Download Membership Application ||Download Microsoft Word Reader || View Criteria

Company Information:
President/CEO:
Business Name :
Contact:
Industry:
Address:
City/State/Zip	|| ||
Phone/Fax:	|| format: xxx-xxx-xxxx
Website:
Email:
Minority Status:
African American || American Indian/Native American || Asian || Women
Disabled American Veteran || Hispanic || Physically/Mentally Disabled
Product or Service:
Member Discount (If applicable):
I would be interested in the following:
Nominating Committee || Membership Recruitment & Development Committee Business Policy & Governmental Affairs Hosting a Meet and Greet at my place of business
Please Indicate Type of Membership (One Year):
Regular Member (For & Non Profits) $ 75   ( 0-10 employees) $150 (11-25 employees) $300 (26-50 employees) $500 (Corporate)	Affiliate Member (Non Voting) $35 (Individual) $15 (Student - High school & Full Time Post) Secondary Requires Guardian Signature, if under 18
Business Partnership Sponsor for CCMBA Programs, Special Events and Scholarship: $750 - $1499 (Silver) || $1500 - $2499 (Gold) $2500 - $4999 (Platinum) || $5000+ (Diamond)
Signature:
|| You will have the option to pay online on the confirmation page

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P.O. Box 1015 Huntingtown, MD 20639 * Phone: 866-517-0477 * info@calvertcountymba.org