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  Chapter Membership Enrollment Form 2009
 
 

 

 * Mandatory  
     
sEPERATOR
     
 
Name  :   Designation(s): :
 
Nickname/AKA :   E-Mail Address :
     
WebSite :
     
Company Name :
     
Mailing Address  :
 
City :   State :
 
Zip :   Business Phone :
 
Ext. :   Fax Number :
 
Home Phone :  

Date of Birth(for
statistical purposes only)

 :
 
Chapter/Division :   Years in Business :
 
Business Classification :   Application Date :
 
Business Type   : C Corp S Corp LLC LLP Partnership Sole Proprietorship
 
Annual Revenue   : 0 – 500K 500K to 1 Mil 1 – 5 Mil   5 – 10Mil 10 Mil +  
 
Who
Recommended
You to Circles
of Color? 		:
 
Current Status  : Minority Business Owner    Corporate Business    Teacher/Student Business Affiliate
 
Membership categories and dues
 
Business Affiliate (Associate Member): First-year dues and application fee are $125.
 
General Business Membership: First-year dues and application fee are $225.
 
Corporate Business Membership: (Available to those who have more than one person from their firm as a COC member.)
First-year dues and application fee are $375.
 
Academic Membership: (Available to full-time professors, teachers and students.) Yearly dues and application
fee are $45. (Full-time status verification, such as ID with status information from your University or class
registration, must be submitted with enrollment form.)
 

By submitting payment and/or the Membership Enrollment Form, I agree to be bound to the Circles of Colors, LLC and
affiliatedChapters' Business Practices, non-competes, Code of Ethics and Standards of Professional Conduct.I will receive
a free business listing on www.cocllc.com. I understand and will agree to the terms set-forth inthe bylaws and all other
Circles of Color documents that govern professional business ethics and membership practices.
 
Name :
 
Signature :   Date :
 
Current Status  : Check   Money Order     
 
Amount :   Check/Money
order Number		 :
 
**** No Cash Accepted ****  Membership fees are for 12 months from the date of acceptance and are subject to change.
Please call for current
 
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