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Coffee with EBMUD Director John Coleman

Membership Application

Contact Name*

First Last

Name of Business*

Business Description - up to 40 words*

Up to 40 words

Email*

Phone*

Fax

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address (if different than Physical Address)

Street Address Address Line 2 City State ZIP Code

Company Web Address

Facebook Web Address

Twitter Web Address

LinkedIn Web Address

Membership Rates - First Year of Annual Dues (Annual Membership Dues are based on the number of full time equivalent employees (FTE) - full time employees = 40 hrs. per week.)*

Membership will be continuous until cancelled by the member or terminated by the Chamber. Membership renewal is billed annually in the month the membership began. To terminate your membership, a 30 day notice is required. FOR QUESTIONS CALL (925) 284-7404 OR EMAIL membership@lafayettechamber.org

Membership Application Fee*

Price: $25.00

One Time for New Members

Additional Information

I would like to receive weekly Chamber email blast
I would like a Map Link on my listing on the Chamber website

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