HOME >> New Member App

Membership Application

Dulles Regional Chamber of Commerce New Member App

 
 
Welcome to The Dulles Regional Chamber of Commerce!


Thank you for completing our 2012 Membership Application form.


*To join and pay Online, complete the form below and click on Submit Application.


*To join and pay by check, complete the application and select Print Application at the bottom of this page then mail to: 3901 Centerview Drive, Suite S, Chantilly, VA 20151. Please make your check payable to The DRCC and note that it is for Membership.

*If you would like information on ACH payment please contact Lauri Swift at 571.323.5308.


Please let us know who referred you to the Chamber and/or how you heard about us in the comments section of the application.


When entering your company name on the form please be careful to enter it the exact way you want it to appear on our Website's Online Business Directory.


Let us know if you DO NOT want your address to show on our Website.

If you have any questions, problems or need help with the application please call us at 703.323.5308 or email us at adonovan@dullesregionalchamber.org
 

Member Application:

* Company Name:  
* Phone:  
* Website:
* Email:
Business Description (200 char max)
Business Keywords:
 
* Physical Address:  
* City/State/Zip:  
Country:
 
Mailing Address: Same as physical address
City/State/Zip:
Country:
 
Business Category:
* Employees: Full-time:      Part-time: 
Comments/Questions:
 
 

Primary Contact Information:

* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
* Email:  
Contact Preference: Email  Phone
 
Social Networking: LinkedIn:
Facebook:
Twitter:
 
Address: Same as Company Address
City/State/Zip:
Country:
 
 

Billing Contact Information:
Same as Primary Contact
* Name (First / Last):  /   
* Title:  
* Phone:  
Cell Phone:
* Email:  
Contact Preference: Email  Phone
 
Social Networking: LinkedIn:
Facebook:
Twitter:
 
Address: Same as Company Address
City/State/Zip:
Country:
 
 
Membership Package:
Sole Proprietorship: $480.00
Two Year Membership
2 to 5 Employees: $640.00
Two Year Membership
6 to 10 Employees: $765.00
Two Year Membership
11 to 25 Employees: $535.00
One Year Membership
26 to 50 Employees: $675.00
One Year Membership
51 to 100 Employees: $950.00
One Year Membership
101 to 300 Employees: $1,650.00
One Year Membership
301 to 999 Employees: $2,100.00
One Year Membership
1000+ Employees: $2,500.00
One Year Membership
Non-Profit - Single Person: $480.00
Two Year Membership
Non-Profit - 2 -5 Employees: $640.00
Two Year Membership
Non-Profit - 6 - 10 Employees: $765.00
Two Year Membership
Non-Profit - 10+ Employees: $500.00
One Year Membership
Charities (501c3) - 1 - 19 Employees: $150.00
Two Year Membership
Charities (501c3) - 20+ Employees: $500.00
One Year Membership
Government Agencies - 1 - 10 Employees: $150.00
Two Year Membership
Government Agencies - 11+ Employees: $500.00
One Year Membership
Veteran (Unemployed Individaul): $100.00
One Year Membership from Military Discharge Date
Full Time Student (no admin fee, please call office): $25.00
One Year Membership
Retired Individual Membership: $100.00
One Year Membership
Additional Fees:
Administration Fee - $35.00
One Time Administration Fee
Payment Option:
Charge my credit card
 
 
Submit Application:
Enter the CAPTCHA words, then press the Submit Application button.
  Submit Application Print Application
 

© 2008-2011 Dulles Regional Chamber of Commerce | 3901 Centreview Drive, Chantilly, VA 20151 | Phone 571 323-5300 | Fax 703 787-8859 | Contact the Chamber

Website developed by D Banzon Design and Katalyst Solutions.