British American Chamber of Commerce..   Broward County
	Membership Application   Make checks payable to :  British American Chamber of Commerce Broward County Mailing Address :  BACC SF, c/o: Roy Yates, 2800 N.E 41st Street,Lighthouse Point,Florida 33064 USA FAX : 954 942 3588 Application Type:  [ ] New Membership     [ ] Renewal Company Name:  ______________________________________________________________ Address:  ____________________________________________________________________ City:  _________________________________  State:  _______  Zip Code:  _____________ Contact Name:  __________________________________  Title:  ______________________ Telephone:  ______________________________  Ext.:  ______  Fax:  __________________ Web Site:  ___________________________________________________________________  Would you like this web site displayed as part of your profile on the BACC Broward County web site?             [  ] Yes, display this web site address.     [  ] No, do not display this web site address. E-mail:  (this e-mail address will not be displayed on the web site)  _____________________________________________________________________________ Brief Business Description:  ______________________________________________________ _____________________________________________________________________________ If you were referred by an existing BACC Broward County member, please tell us! Member Company:  ______________________________________________________________ Contact Name:  _________________________________________________________________ Web site contact preference:  (select one) As a BACC Broward County member you are entitled to one free "baccbroward.org" e-mail address.   You can select to use the BACC e-mail address, a personal or business e-mail address, a contact telephone number, or none for contact through the BACC Broward County web site.  This is the contact information that will be displayed to viewers of the BACC Broward County web site, including potential business contacts.    [  ]  baccsouthflorida.org e-mail address [  ]  My own e-mail address (please specify): __________________________________________ [  ]  Telephone number (please specify): ______________________________________________ [  ]  Do not post any contact information on the BACC Broward County web site Membership Type:  (select one) [  ]  Trustee ($1,050.00 US per year)               [  ]  Individual ($150.00 US per year) [  ]  Corporate ($350.00 US per year)               [  ]  Foreign Business ($150.00 US per year) [  ]  Small Business ($250.00 US per year)         [  ]  Student ($25.00 US per year)   Category:  (select the one that best describes you or your company)   [  ]  Professional Services (i.e. Medical, Law, Accounting, etc.) [  ]  Real Estate / Property Management [  ]  Travel (i.e. Airline, Cruise Line, Ground Transportation, Agency, etc.)                    [  ]  Technology & Telecommunications    [  ]  Printing / Graphics / Publishing                                 [  ]  Insurance / Risk Management / Security   [  ]  Banking / Financial / Investment      [  ]  Consumer Sales (i.e. Automotive Dealer, Retailer, etc.)                      [  ]  Shipping / Distribution / Logistics / Freight Forwarding [  ]  Manufacturing / Assembly / Distribution [  ]  Individual (use only if membership type is Individual or Student) [  ]  Miscellaneous / Other:  _________________________________         All membership applications are subject to approval by the British American Chamber of Commerce Broward County Board of Directors.
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