West Central Georgia Black Chamber Membership Application Form

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

example@example.com

Phone Number (Best Contact Number)*

Please enter a valid phone number.

Business Name

Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What County is Your Business in?

Business Email

example@example.com

Business Cellular Number

Work Number

Number of Years in Business

Business Industry

Please list Your Business Industry if "other"

Business Structure

Brief Descriptions of Your Business or Services

Does Your Business Have any Certifications?

Website URL

Social Media Handles (FB, Instagram, LinkedIn, "X", Snapchat)

Number of Employees

Is Your Business 51% Minority Owned?

YesNo

Is Your Business 51% Minority Woman Owned?

YesNo

Why Did you Decide to Join the Chamber? (Select All That Apply)

What are Your Top Business Needs Right Now?

What Type of Chamber Programs/Events Interest You?

Would You Like to be Considered for....

Membership Levels

SoloPreneur - For Consultants, Creatives, Independent Professionals, and Small Business Owners without employees Product Image

SoloPreneur - For Consultants, Creatives, Independent Professionals, and Small Business Owners without employeesBenefits: One complimentary vendor booth per year. One ticket to either the Business Expo or Gala. Host a Meet & Greet at your business location. Ribbon cutting ceremony (optional) Business spotlight on social media. One 30-minute “Ask an Expert” consult with a WCGBC partner. New member recognition and celebration. Monthly WCGBC newsletter with community updates. Listed in WCGBC Business Directory (digital & printed) Discounted event tickets (forums, summits, networking)

$250.00

Emerging Business - Ideal for Growing Business Ready to Engage Deeper Product Image

Emerging Business - Ideal for Growing Business Ready to Engage DeeperBenefits: Two complimentary vendor booths annually. Two tickets to the Business Expo or Gala. Chamber decal to display in storefront. Ribbon cutting ceremony. Host a Meet & Greet at your location. Access to WCGBC Membership Portal. Legislative, procurement, and bid notifications. Social Media Business spotlight. New member recognition and celebration. Monthly WCGBC newsletter with community updates. Listed in WCGBC Business Directory (digital & printed)

$275.00

Premiere Business - For Established Businesses Looking for Visibility and Access Product Image

Premiere Business - For Established Businesses Looking for Visibility and AccessBenefits:Three tickets to the Business Expo or GalaHost Meet & Greets and be featured on event materialsCustomized e-blast article spotlighting your businessFeatured listing in WCGBC Business DirectoryPriority speaker slot on Monthly Monday Zoom sessionAccess to WCGBC Membership PortalRibbon cutting ceremonyLegislative, procurement, and bid notificationsSocial media business spotlightNew member recognition and celebrationMonthly WCGBC newsletter with community updatesListed in WCGBC Business Directory (digital & printed)

$550.00

Non-Profit - For 501(c)3 or Community-Based Organizations Product Image

Non-Profit - For 501(c)3 or Community-Based OrganizationsBenefits:New member recognition and celebrationMonthly WCGBC newsletter with community updatesListed in WCGBC Business Directory (digital & printed)Discounted event tickets (forums, summits, networking)One annual feature in the WCGBC “Nonprofit Spotlight” e-blast

$175.00

Community Supporter - Perfect for individuals, retirees, or those who want to support small business growth in West Central Georgia. Product Image

Community Supporter - Perfect for individuals, retirees, or those who want to support small business growth in West Central Georgia.Benefits:Recognition as a Supporter MemberSubscription to WCGBC monthly e-newsletterListed in the WCGBC Supporter Directory

$100.00

Corporate Investor - For corporations, banks, universities, and large firms investing in regional equity and growth. Product Image

Corporate Investor - For corporations, banks, universities, and large firms investing in regional equity and growth.Includes all Business Premier benefits, PLUS:Four tickets to the Annual Chamber GalaLogo placement on all major event bannersGuaranteed seat on WCGBC Legislative & Procurement RoundtableSpeaking opportunities at two WCGBC networking eventsFeatured logo and recognition on all event programs

$1,500.00

Total

$0.00

Date of Signature*

Date

Signature*

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Billing Adress

Use the address above.I want to specify a different billing address.

Payment Methods

Debit or Credit Card

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

West Central Georgia Black Chamber Membership Application

Basic Member Information

Business Profile Information

Membership Type & Payment