Business Empowered International Mississippi Chamber Member Application

Business Empowered International Mississippi Chamber Member Application

PLEASE COMPLETE BELOW
I am applying as a ... (Check one of the following)*

New MemberExisting Member (Renewal)
What state are you registering under?*
Are you an American citizen?*
What country do you reside in?
Are you a referral?

YesNo
If so, who referred you?
How did you hear about Business Empowered?

Social MediaWebsiteFriendOther
I am a...

Business OwnerCommunity Advocate/LeaderBoth
Applicant's Name

First NameLast Name
Applicant's Title/Position*
Spouse’s Title/Position (Only if you are applying as MARRIED COUPLE)
Spouse’s Full Name

First NameLast Name
Name of Business/Organization
Phone Number*

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Email*
example@example.com
Website
Social Media Links
Tell us about your business in 250 words or less.
Upload Your Headshot*

Browse Files

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Upload Your Company Logo

Browse Files

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I am interested in becoming a chamber ambassador

YesNo
Select An Ambassadorial Program

The Pink CEO Women's LeagueThe Barbers & Beauty ExecutivesThe Healthcare Advocacy DivisionThe Ultimate Event PlannersMarketplace Ministry AmbassadorBusiness Empowered Mississippi Men's League
The application can be submitted by mail. Please print the PDF version of this membership application by clicking the print button below and mail it along with your check or money order to Business Empowered Mississippi, Attention: New Member, P.O. Box 2683, Madison, MS 39130-2683 OR submit your payment below.
Before checking out, please select your annual membership level.*

INDIVIDUAL: (RETIRED OR NON-BUSINESS} - $59MARRIED COUPLE (RETIRED OR NON-BUSINESS) - $1091 BUSINESS OR COMMUNITY LEADER - $1091 BUSINESS OR COMMUNITY LEADER MARRIED COUPLE - $179NON-PROFIT: - $1891-5 EMPLOYEES - $1996-25 EMPLOYEES - $29926-50 EMPLOYEES - $39951 OR MORE EMPLOYEES - $599STUDENT (COLLEGE OR TRADE) - $25

Checkout: Use the discount code “BBB25” to get 25% off at checkout. This only applies for Business/Community Leaders, Nonprofits, 1-5 Employees and higher.

High School or College Student$25.00

INDIVIDUAL: RETIRED OR NON-BUSINESS MEMBER$59.00

Membership Type

1 BUSINESS OR COMMUNITY LEADER$109.00

Membership Type

NON-PROFIT$189.00

1-5 EMPLOYEES$199.00

6-25 EMPLOYEES$299.00

26-50 EMPLOYEES$399.00

51 OR MORE EMPLOYEES$599.00

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Subtotal $0.00Tax $0.00Total $0.00

Payment Methods

Credit Card

Afterpay

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