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<TITLE>Greater Mainland Chamber of Commerce ~~ Application for Membership</TITLE>
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<FONT SIZE=6 COLOR="YELLOW">Greater Mainland<BR>
<I>Chamber of Commerce</I></B></CENTER></FONT>
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<H1><FONT COLOR="RED">Application for Membership</FONT></H1>

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<FORM METHOD="POST" ACTION="http://iloveac.com/cgi-bin/join.pl">
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    <TD ALIGN=RIGHT><B>Name of Business:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="NAME" SIZE=48></TD>
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  <TR>
    <TD ALIGN=RIGHT><B>Telephone Number:</B></TD>
    <TD><INPUT TYPE="TEXT" NAME="PHONE" SIZE=15></TD>
    <TD><B>Fax Number:</B></TD>
    <TD><INPUT TYPE="TEXT" NAME="FAX" SIZE=15></TD>
  </TR>
 <TR>
    <TD ALIGN=RIGHT><B>E-Mail Address:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="EMAIL" SIZE=40></TD>
  </TR>

  <TR> 
    <TD ALIGN=RIGHT><B>Type of Business:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="TYPE" SIZE=40></TD>
  </TR>
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    <TD ALIGN=RIGHT><B>Name of Parent Company:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="PARENT" SIZE=40>
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    <TD ALIGN=RIGHT><B>Street:</B></TD> 
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="STREET" SIZE=25></TD>
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    <TD ALIGN=RIGHT><B>City:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="CITY" SIZE=25></TD>
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  <TR>
    <TD ALIGN=RIGHT><B>State:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="STATE" SIZE=3 MAXLENGTH=2>
    <B>Zip:</B>
    <INPUT TYPE="TEXT" NAME="ZIP" SIZE=11 MAXLENGTH=10></TD>
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    <TD ALIGN=RIGHT><B>Name of Contact:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="CONTACT" SIZE=50></TD>
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    <TD ALIGN=RIGHT><B>Number of Employees:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="EMPLOYEES" SIZE=7>
    <B>Dues $</B>
    <INPUT TYPE="TEXT" NAME="DUES" SIZE=15></TD>
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    <TD ALIGN=RIGHT><B>Referred by:</B></TD>
    <TD COLSPAN=3><INPUT TYPE="TEXT" NAME="REFERRED" SIZE=50></TD>
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    <B>Please have a Chamber represenative contact me:</B>
    <INPUT TYPE="RADIO" NAME="CONTACT-ME" VALUE="Yes" CHECKED>
    <B>Yes</B>  &nbsp; &nbsp;
    <INPUT TYPE="RADIO" NAME="CONTACT=ME" VALUE="No"><B>No</B>
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<B>Issues most concerning my company:<BR>

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   <INPUT TYPE="SUBMIT" VALUE="Submit Membership Application"> 
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<H2>Express Index</H2>

[ <A HREF="presmess.html">President's Message</A> | <A HREF="officers.html">Officers</A> | <A HREF="mission.html">Mission Statement</A> | <A HREF="mixer.html">Mixer</A> ]<BR>
[ <A HREF="calendar.html">Calendar of Events</A> | <A HREF="join.html">Application for Membership</A> ]

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    <TD><CENTER><B>The Greater Mainland Chamber of Commerce Internet<BR> 
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