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Membership Application

Dulles Regional Chamber of Commerce New Member App

 
 
To join the Dulles Regional Chamber of Commerce please complete the form below.

In comments please list who referred you to our Chamber and/or how you heard about us.

When entering your information please be careful to enter your company name exactly the way you want it to appear on our Website's Members' Business Listing. If you DO NOT want your business address to show on our website, please let us know with a notation in the comments area.

To pay online by credit card, complete the form and payment information section and click Submit Application.

To join and pay by check, complete the application and select Print Application at the bottom of the page. Mail the application and a check made payable to DRCC, please note on the check: New Membership. Our address is 3901 Centerview Drive, Suite S, Chantilly, VA 20151

All membership rates are based on your combined total number of employees, contractors and representatives.

If you have any questions or need help with the application please call Lauri Swift at 571-323-5308.
 

Member Application:

* Company Name:  
* Phone:  
* Website:
* Email:
Business Description (200 char max)
Business Keywords:
 
Minority Designation - 1st:
Minority Designation - 2nd:
 
* 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
Login:
Password:
 
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
Login:
Password:
 
Social Networking: LinkedIn:
Facebook:
Twitter:
 
* Address: Same as Company Address
* City/State/ZIP:
Country:
 
 
Membership Package:
Sole Proprietorship: $496.00
Two Year Membership
2 to 5 Employees: $663.00
Two Year Membership
6 to 10 Employees: $795.00
Two Year Membership
11 to 25 Employees: $557.00
One Year Membership
26 to 50 Employees: $702.00
One Year Membership
51 to 100 Employees: $988.00
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 answer, then press the Submit Application button.
What is the sum of 6 plus 9?
  Submit Application Print Application
 

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