80 North 200 West Delta

APPLICATION

                                                                      76 North 200 West
                                           Delta, UT 84624
                                            435-864-4316

           member@deltaareachamberofcommerce.com

           M E M B E R S H I P APPLICATION

APPLICATION IS HEREBY GIVEN FOR MEMBERSHIP IN THE DELTA AREA CHAMBER OF COMMERCE. FOR THE CHAMBER’S COMMUNITY PROGRAMS AND SERVICES, THE UNDERSIGNED AGREES TO INVEST.
Membership Fees Are Due January 31, 2004. Please make arrangements for late applications.

NAME OF FIRM________________________________________     _______________________

    REPRESENTATIVE______________________________________________________________

ADDRESS______________________________________________________________________

________________________________________________________________________________

TELEPHONE #___________________________________FAX#____    ____________________

E-MAIL ADDRESS______________________________________________________________

Web Address

SIGNATURE ________________________________________________DATE_____________

COMMITTEE YOU WOULD LIKE TO HELP WITH


2004 MEMBERSHIP INVESTMENT SCHEDULE

INDIVIDUAL & FARM RELATED--------------------------------------------- 35.00
Membership Plaque--------------------------------------------------------- 10.50

    BUSINESS

   1-5 PEOPLE ---------------------------------------------------------------   50.00

   6-10 PEOPLE -------------------------------------------------------------- 120.00

  11-20 PEOPLE ------------------------------------------------------------- 180.00

  21 + PEOPLE & INDUSTRIAL ----------------------------------------- ---- 350.00

                                                                                                  2004 Dues $_________

    ALL BUSINESS AND INDUSTRIAL MEMBERSHIPS INCLUDE ONE (1) REPRESENTATIVE, MEMBERSHIPS FOR ADDITIONAL EMPLOYEES ARE $35.00 each. Plaque not included

    TWO (2) PART-TIME EMPLOYEES EQUAL ONE (1) FULL-TIME EMPLOYEE.

    MEMBERSHIP INVESTMENT ENTITLES THE INDIVIDUAL OR FIRM TO FULL MEMBERSHIP PRIVILEGES AS PROVIDED BY THE DELTA AREA CHAMBER OF COMMERCE BYLAWS AND SHALL REMAIN IN EFFECT WHILE MEMBERSHIP INVESTMENT IS MAINTAINED. THANK YOU.

YOU MAY BE ABLE TO DEDUCT YOUR DUES AS A BUSINESS EXPENSE.

Please send this form with your check payable to the Delta Area Chamber of Commerce
"Your membership in the DACC doesn't cost it pays"

member@deltaareachamberofcommerce.com