Member Application Business Information Company Name: * Leave Blank: Phone: * Website: Email: * Business Description (500 char max): Directory Category: --- Select Primary Category --- 24 hr emergency service Air Conditions Services Apartments Assisted Living Attorneys Auto Dealer Auto Repair Awards and Trophies Bank Beauty Building Building/ Construction Business Offices cleaning Church Computer Network Design/Repair/ Maintenance Computer Services Customized Computer Training Education Elected Officials Employment Services Entertainment Finance Fitness Center Funeral Golf Course Government Health Care Healthcare/General Surgery Home Cleaners Home Health Home Health Provider Hotel Ice Carvings Individual Member Industrial Insurance Job fairs Lawn Manufacturing & Production Marketing Promotions Mortgage/ Loans Non-profit Organizations Photography Productions Promotions Real Estate Restaurant Retail Security Spa Transportation Veterinarian Waste pickup Web Development/Web Hosting Employees: Full-time Part-time Business Keywords (enter a space between words): Comments / Questions: Physical Address Line 1: * Line 2: City: * State: * Postal Code: * Country: * --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Mailing Address Same as physical address Line 1: Line 2: City: State: Postal Code: Country: --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Primary Contact Information First Name: * Last Name: * Title: Phone: * Email: * Contact Preference: Email Phone Login: * Password: * Address Same as Member Address Line 1: Line 2 City: State: Postal Code: Country: --- Select Country --- Afghanistan Albania Algeria Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belgium Belize Bolivarian Republic of Venezuela Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Cambodia Cameroon Canada Caribbean Chile China Colombia Congo [DRC] Costa Rica Croatia Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Faroe Islands Finland France Georgia Germany Greece Greenland Guatemala Haiti Honduras Hong Kong Hong Kong SAR Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Kyrgyzstan Lao PDR Latin America Latvia Liechtenstein Lithuania Luxembourg Macao SAR Macedonia (Former Yugoslav Republic of Macedonia) Malaysia Maldives Mali Malta Mexico Moldova Mongolia Montenegro Morocco Myanmar Nepal Netherlands New Zealand Nicaragua Nigeria Norway Oman Pakistan Panama Paraguay Peru Philippines Poland Portugal Principality of Monaco Puerto Rico Réunion Romania Russia Rwanda Saudi Arabia Senegal Serbia Serbia and Montenegro (Former) Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sweden Switzerland Taiwan Tajikistan Thailand Trinidad and Tobago Tunisia Turkey Turkmenistan U.A.E. Ukraine United Kingdom United States Uruguay Uzbekistan Vietnam Yemen Membership Options Membership Package: * Student: $10.00 Needs to be a student Non-Business Individual Members: $75.00 For non-business individuals who wish to participate. Business Individual Members: $100.00 Individuals in a business. Non-Profit Organizations: $100.00 Needs to be a non-profit organization. 1-5 employees: $200.00 1-5 full time employees (2 part time employees equals 1 full time) 6-10 Full Time Employees: $225.00 6-10 full time employees (2 Part time employees equal 1 full time) 11-15 Employees: $250.00 11-15 full time employees ( 2 part-time employees equals 1 full-time) 15-20 Employees: $275.00 15-20 full time employees (2 Part time employees equal 1 full time) 21-25 Employees: $325.00 21-25 full time employees (2 Part time employees equal 1 full time) 26-30 Employees: $355.00 26-30 full time employees (2 Part time employees equal 1 full time) 31-35 Employees: $380.00 31-35 full time employees (2 Part time employees equal 1 full time) 36-49 Employees: $425.00 36-49 full time employees (2 Part time employees equal 1 full time) 50-75 Emoloyees: $480.00 50-75 full time employees (2 Part time employees equal 1 full time) 76-100 Employees: $525.00 76-100 full time employees (2 Part time employees equal 1 full time) 101-125 Employees: $575.00 101-125 full time employees (2 Part time employees equal 1 full time) 126-150 Employees: $625.00 126-150 full time employees (2 Part time employees equal 1 full time) 151-175 Employees: $675.00 151-175 full time employees (2 Part time employees equal 1 full time) 176-200 Employees: $725.00 176-200 full time employees (2 Part time employees equal 1 full time) Payment Option: Bill me Charge my credit or debit card I have read and accept the privacy policy of Brazoria County Hispanic Chamber of Commerce. I grant Brazoria County Hispanic Chamber of Commerce permission to contact me regarding my account, news, updates, and offers. Please read and accept the privacy policy before continuing. Print Application
