Language
English (US)
Spanish (Latin America)
Cen-Tex Hispanic Chamber of Commerce Membership Form
Contact Information
Primary Contact Full Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Phone Number
Please enter a valid phone number.
Secondary Contact Full Name (Optional)
First Name
Last Name
Secondary Contact Email
example@example.com
Secondary Contact Phone Number
Please enter a valid phone number.
Membership Options
Membership Level
Corporate Business (251+Employees)- $1,000
Major Business (25-250 Employees)- $400
Small Business (3-24 Employees)- $200
Micro-Business (1-2 Employees)- $150
Non-Profit- $125
Individual Supporter- $50
Student- $50
Senior- $50
Employer/Affiliation
*
Business/Organization Information
Name of Business/Organization
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Website
Instagram
Facebook
LinkedIn
Business Category
*
Short description of your business/organization
*
Logo
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have any promotional items that you want to include in our New Member Welcome Package? If yes, we will be contacting you to identify a pick-up date.
*
Yes
No
Not Yet
Additional Information & Payment
How did you hear about us? (If referred by someone, please share by who)
*
Reason(s) for joining
*
Are you interested in a ribbon cutting? If yes, we will follow up with you to select a date.
*
Yes
No
Are you interested in coming on Noticias (a Waco Cable Channel News production filmed at City Hall) for a 13 minute interview to showcase your business/organization?
*
Yes, in English
Yes, in Spanish
Not at the moment
Payment
If you would like to be invoiced, please email Dytrun@wacohispanicchamber.com
Pay online via our website below. Click the button that says "Pay with Credit Card" to complete your payment.
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform