By signing below I acknowledge that I am authorizing the DC Chamber of Commerce to charge my credit card for the amount
Emerging Professionals Program Membership Application
1. Tell Us about Yourself
Name: ___________________________________________________________________________ Title:
____________________________________________________________________________
Company Name: ____________________________________________________________________ Phone: _________________________
Fax: _________________________
E-mail: ______________________________
Date of Birth: __________________________
Address: ________________________________________________________________ City: _________________________________ State: _______________ Zip Code: _________ Mailing Address (if different from above): ______________________________________________________ City: ______________________________________State: _______________ Zip Code: _________ Twitter: ____________________ Facebook: ________________ Instagram: _____________________
Are you a DC Chamber member?
☐ YES
☐ NO
How did you hear about the Young Professionals Program?
____________________________________________________________________ What are you looking for in the Young Professionals Program? (Check all that apply)
☐ ☐ ☐ ☐
Advocacy ☐ Member Discounts Business Education ☐ Networking Visibility ☐ Social Events Other ________________________________ Please return to:
Membership Dues: Student Member Young Professional
☐ $50 ☐ $75
The DC Chamber of Commerce ATTN: Ben Casey Tel. (202) 347-7201 Fax (202) 638-6762
[email protected]
Payment Method: ☐Visa
☐Master Card ☐American Exp. ☐Check
CC #: _______________________
Exp: ________ Signature: __________________________________
By signing below I acknowledge that I am authorizing the DC Chamber of Commerce to charge my credit card for the amount indicated. Signature: ___________________________________________ Date: ____________________________