Membership
form
Organization
Name
Address
State
Zip
Phone
Fax
Mobile
Email
Web address
Corporate
Sponsorship
______
Platinum (C) Member
$5,000.00
______
Gold (C) Member
$4,000.00
______
Silver (C) Member
$2,500.00
______
Bronze (C) Member $1,000.00
VIP Member
VIP Member $250.00
to $1,000.00
Business
Member
______
Business Member $
100.00
Organization
Member
______
Organization Member $
75.00
Individual
Member
______
Individual Member $ 50.00
______
Student or Volunteer Member $ 25.00
________________________________
Signature
Date
Mail to: African American Chamber of
Commerce, Lubbock PO BOX 1796 Lubbock, Texas
79408 | 
