Emerging Professionals Program Membership Application

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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: ____________________________