Membership Application Form

Business Name (Please include “LLC, LP., INC., Etc.)

Full Name of majority owner or proxy:

Title/Position

Business Address

City (If outside Elmwood Park)

State (If Outside New Jersey)

Zip (If outside 07407)

Phone Number of Member

Email Address for primary contact

Business Phone

If you were referred by an existing chamber member, please provide their primary contact information:

**Business Information:**

Industry/Field

Year Established

Business Website

Description of Products/Services

**Membership Type:**

Please select the Yearly membership type you are applying for:

Supporter (Non-voting) $25…Renewal* $25 Individual Membership $50…Renewal* $40 Small Business Membership (2-10 employees) $75…Renewal* $60 Medium Business Membership (11-50 employees) $125…Renewal* $100 Large Business Membership (51+ employees) $200…Renewal* $150

**Optional survey**

What do you hope the Chamber will accomplish in the future?

**Referral:**

If you were referred by an existing chamber member, please provide their primary contact information:

Name

Contact Method

Email Phone Number

Phone Number

**Declaration:**

I here by apply for membership/association in the New Elmwood Park Chamber of Commerce and agree to abide by its by laws and code of conduct. I understand that membership dues are payable annually, are non-refundable and not Tax Deductible. I certify that the information provided in this application is true and accurate to the best of my knowledge.

Printed name of Applicant

Signature

Assumption of Voting Rights and Privileges Upon Application Approval

Upon receipt and approval of application, the member or proxy immediately assumes voting rights and all privileges according to the provisions of the most current by-laws. An original copy of this document will be kept on file up to one year following withdrawal from the organization.

Membership Renewal and Grace Period Policy

*Renewal- Grace period extends up to the end of the thirteenth month from membership inception(month), whereafter the renewal rate will expire. Upon annual renewal, all information contained herein will be considered true and accurate unless updated by the signatory and filed with the current Chamber Secretary.