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Welcome to the African American Chamber! To serve you better, please fill out this application, as we will use this information to help provide you with services you need to ensure the success of your business. Please be advised that in filling out this application you acknowledge understanding of the African American Chamber of Commerce. All information gathered in this application is completely confidential and will only be shared amongst the AACC for the sole purpose of assisting the Chamber with assessing member needs and recommending services. |
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Member Application: |
| * Company Name: |
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| * Phone: |
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| Website: |
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| * Email: |
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| Business Description (200 char max) |
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| Business Keywords: |
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| * Physical Address: |
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| * City/State/ZIP: |
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| Country: |
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| Mailing Address: |
Same as physical address
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| City/State/ZIP: |
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| Country: |
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| Business Category: |
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| Employees: |
Full-time:
Part-time:
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| Comments/Questions: |
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Primary Contact Information: |
| * Name (First / Last): |
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| Title: |
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| * Phone: |
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| Cell Phone: |
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| Fax: |
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| * Email: |
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| Contact Preference: |
Email
Phone
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| Social Networking: |
LinkedIn: |
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Facebook: |
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| Address: |
Same as Company Address
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| City/State/ZIP: |
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| Country: |
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Billing Contact Information: |
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Same as Primary Contact
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| * Name (First / Last): |
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| Title: |
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| * Phone: |
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| Cell Phone: |
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| Fax: |
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| * Email: |
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| Contact Preference: |
Email
Phone
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| Social Networking: |
LinkedIn: |
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Facebook: |
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| Address: |
Same as Company Address
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| City/State/ZIP: |
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| Country: |
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| Membership Package: |
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  If using fee schedule, enter fee here:
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| Additional Opportunities: |
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We will contact you with additional information. |
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| Payment Option: |
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Charge my credit card |
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| Submit Application: |
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Enter the CAPTCHA answer, then press the Submit Application button. |
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What is the sum of 9 plus 5?
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Submit Application
Print Application
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