Membership Application Please circle Primary or Secondary applicant Applicant Name*_____________________________________________________________________ Business Name*______________________________________________________________________ Preferred Mailing address_____________________________________________________________ Business

phone_________________________________Preferred Phone_______________________ Email address_______________________________________________________________________ Website address_____________________________________________________________________ *name and business provided will be printed on Name Badge. I hereby authorize the Chamblee Business Association to publicize in any manner as determined by the Board of Directors, including but not limited to publication in a member directory, any information provided by me or my company in the memberhip application. I hereby release the Chamblee Business Association and its officers and members from any and all liabilty with respect to the publication of this information. __________________________________________________________________Date_____________ Signiture of Applicant

Please let us know how you would like to help us grow: Committes available o Membership o Speaker Committee o Corporate Development o Chamblee Business Expo o Economic Development o Community Services o Leadership o Marketing/Communitcation o Government Relations o Legislative Kick-Off Reception o Other_______________________________________________________________________

Chamblee Business Association, PO Box 81743, Chamblee, GA 30366-1743 Membership application page 1

Membership Levels All memberships enjoy the following benefits: Monthly Meetings with guest speakers Monthly Business After Hours Online Business directory Online Chamblee Business news Marketing table available at general meetings for you to display your business materials Midsize membership include the following upgrades: Opportunity to sponsor Business After Hours at your business location. Sponsor to provide refreshments and door prizes Corporate membership (6 available) Business After Hours sponsorship Meeting sponsorship, with speaker of your choice Silver membership (5 available) Business After Hours sponsorship Meeting sponsorship, with speaker of your choice Recognition of membership on website Gold/Harris membership (1 availble) Business After Hours sponsorship Meeting sponsorship with speaker of your choice Recognition of membership on website Meeting sponsorships are availble for $150.00. 2 sponsors may co-sponsor meeting together Business after hour sponsorships are availble for $100.00 plus refreshments and door prizes Please choose your membership level: all memberships are on an annual calendar renewal Prepay for your general meetings in advance, you pay for 10 and get 12 per calendar renewal total charge or $50.00 per person per annual renewal.

Chamblee Business Association, PO Box 81743, Chamblee, GA 30366-1743 Membership application page 2

Individual $100.00 ____1___ # members ________# of prepaid general meetings collected Partnership $150.00 ____2___ # members ________# of prepaid general meetings collected

________total

________total

Company $250.00 For companies with 3-49 employees, up to 3 persons allowed to attend meetings and functions as members _______ # members ________# of prepaid general meetings ________total collected Corporate $500.00 For companies over 50 employees, up to 5 persons allowed to attend meetings and functions as members _______ # members ________# of prepaid general meetings ________total collected Silver $750.00 10 membership available up to 5 persons allowed to attend meetings and functions as members _______ # members ________# of prepaid general meetings ________total collected Gold/Harris $1000.00 1 membership available, up to 8 persons allowed to attend meetings and functions as members. _______ # members ________# of prepaid general meetings ________total collected

Please have each additional member complete page 1 of application and mark as secondary applicant.

Chamblee Business Association, PO Box 81743, Chamblee, GA 30366-1743 Membership application page 3