Member Applications > General Membership

Name:
Organization:
Mailing Address:
Mailing Address cont.:
City:
State:
Zip:
Telephone:
Type of Business:
Fax:
Email Address:
I am a member in good standing of the following chamber(s) of commerce:

DUES are $250 per individual member annually, payable by Sept. 30th for the Oct. 1st to Sept. 30th Fiscal Year.

You may print this form and mail it to the East Polk Committee of 100 at P.O. Box 1420, Winter Haven, FL 33882.

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