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2010 Membership Application

Please complete the form below to begin the application process. Once iyour application is received, a Chamber representative will contact you to obtain payment and confirm your membership.

The information you provide about your business will be published on www.BreaChamber.com and in our annual printed Member Directory & Community Guide. People who wish to do business with you rely on us to provide them with accurate information.

PLEASE ENSURE THAT YOUR INFORMATION IS LISTED CORRECTLY.

Company Name*
Street Address*
City*
State
Zip*
This is a home-based business. Do not publish my address.	Yes
Phone*
Fax
Web Site
Referral Contact Name*
Title
E-mail*

Billing Address - same as street address?	Yes
Billing Address
City
State
Zip
Billing Contact Name*
Title
Phone
E-mail

Number of FT Employees*
Number of PT Employees*
Industry	Retail Service Manufacturing / Distribution
Primary Classification
Business Description
Why are you joining the Brea Chamber	Advocacy Connections Community Involvement Visibility Education Member Discounts
Please provide me with more information about	Economic Development Workforce Development Legislative Action Educational Seminars Advertising Opportunities Networking Events Community Promotion Business Expo Becoming an Ambassador Volunteer Opportunities