First Name: Initial Last Name: ================================================================== Business Information
(If you do not have business,skip to the next section.)
Company (if any): Business Title: Business Address: Business Address 2: City: State: Zipcode: Business Phone: Ext. Alt. Business Phone: Fax: Email: Type of Business (example: Grocery Store, Professional Services, Education, etc.) Are you the owner of the business? How long has the company been in business? Which of these does your company fall into? DBA Corporation Partnership ===================================================== Personal Information (please make sure you insert your email) Residential Address: Residential Address 2: City: State: Zipcode: Home Phone: Cell Phone: Email: (if same as above, leave blank) Ethnicity: ===================================================== Membership Desired
Thank you for taking your time to fill out the online membership application. In order for this application to be processed ALL FIELDS MUST BE FILLED. If you need assistance, please contact someone at our office 746-1989 or email miguel@masslatinochamber.com.
