Covert Membership Payment Form

Date

MonthDayYear
How To Use This Form
1. Fill out the contact info to simply get in touch with us.
2. Choose and purchase a Membership Plan right from the form.
3. Choose to pay for a Sponsorship right from the form.
Company Name*
Contact Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
E-mail*
example@example.com
Website*
Additional Info
The totals below include credit card processing fees.
Membership Plans
prevnext( X )
Non-Profit MembershipMembership for one year for Not-for-Profit Organizations with (1) representative + late fee
$103.00



Single MembershipFor businesses with one (1) representative• Features your business on the Chamber’s website• Features your business on Covert Avenue Chamber of Commerce Instagram platform and Facebook platform + late fee
$181.00



Blue Diamond SponsorshipConstant Banner on page bottom, all devices - Logo w/website link + late fee
$300.00



Pink Diamond SponsorshipScrolling Banner, middle page positions, all devices - Logo w/website link + late fee
$150.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.