2023 MEMBERSHIP APPLICATION

BLACK CHAMBER OF COMMERCE OF LAKE COUNTY

668 Lenox Avenue - Waukegan, Illinois 60085-6402

Office (847) 596-2910 Fax (847) 596-2912

"Transforming Today’s Businesses for Tomorrow Challenges"

www.bcclcinc.org

2023 MEMBERSHIP APPLICATION

CELEBRATING 17 YEARS!
Business Name or Individual Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email*
example@example.com
Website Address (if applicable / inquire how to link your website to the BCCLC):
Total Number of Employees: *
(2 Part-Time = 1 Full-Time)
Please indicate your preference in receiving information either through fax or e-mail and place your initials as authorization to do so. I prefer to be:*

FaxEmailOther
Representative:*
Principal Representative:
Representative: Email*
example@example.com
Alternative Representative::
Principal Representative:
Alternative Representative: Email
example@example.com
BUSINESS CLASSIFICATION: (For Membership Directory & Community Guide) (Please describe your Business, and be specific as possible.)
INVESTMENT FEE SCHEDULE
Membership Cost (From Investment Fee Schedule)
prevnext( X )
Individual Membership (Non Business) $50.00

Sole Proprietor$75.00

Branch Membership (1-4) Employees$125.00

Branch Membership (5-9) Employees$135.00

Branch Membership (10-24) Employees$215.00

Corporate Membership (25-49)$235.00

Corporate Membership (50-74)$375.00

Corporate Membership (75+) $500.00

Subtotal $0.00Tax $0.00Total $0.00
Commitment to the BCCLC

I am committed to the Black Chamber of Commerce of Lake County. My membership is renewed annually from the anniversary month of joining and to remain a member in good standing I will pay my dues within 60 days of that anniversary date.
Authorized Signature

Clear
Title*
Date*

MonthDayYear
Date
If you choose to scan & email, please email lydia.lewis@bcclcinc.org or mail the application to the address listed above.
Should be Empty: