Member - Broomfield Chamber of Commerce

Business Information

Company Name: *

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Phone: *

Website:

Email: *

Directory Category: *

Employees: *

Full-time Part-time

Comments / Questions:

How did you hear about the Chamber?: *

Expectations: *

My services are best described as:

What are you hoping to gain access to through membership? :

Are you interested in sponsorship opportunities? :

What is your biggest goal? :

What opportunity or program are you most excited to be a part of as a Broomfield Chamber member? :

What is your industry? :

Briefly describe your best or current clients:

Physical Address

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City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Twitter Youtube Pinterest Google+ Blogger Instagram

Primary Contact Information

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title: *

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Small Nonprofit Membership: $250.00
Designed for 501c3 nonprofits with an annual budget of $100K or below. 0-9 Full Time Employees: $345.00
10-24 Full Time Employees: $400.00
25-59 Full Time Employees: $600.00
60-99 Full Time Employees: $800.00
100-299 Full Time Employees: $1,200.00
300-499 Full Time Employees: $1,800.00
500+ Full Time Employees: $3,400.00

Additional Fees:

One-time administration fee : $35.00
A one-time $35 administration fee

Payment Option:

Bill me Charge my credit or debit card

Member Application

Mailing Address

Address

Address