New Membership Application
Contact Name
Title
[Business] Name
[Business] Address
Year Established
Product or Service
City
State
Zip
Phone
Fax
Cell
E-mail
Web Site
Referred by
ANNUAL MEMEBERSHIP FEE GRID
Fee is based on full-time employees-2 part-time employees =1 full-time employee
$125.00 per year
$185.00 per year
$250.00 per year
$375.00 per year
Are you a(n)...
Business 1-5 Employees
Business 6-25 Employees
Business 26-50 Employees
Business 51+ Employees
$65.00 per year
Non-business affiliated (Individual)
$60.00 per year
Retirees
$125.00 per year
Non-Profit/ Churches
$155.00 per year
Civic Organizations (government, fire, police, library, senior citizens)
$155.00 per year
Schools
$480.00 per year
Financial Institutions/Utilities/Hospitals
$25.00 One time
New Member Processing Fee (non-refundable)
$50.00 per year
Web Site Listing
Interested in volunteer opportunities...................................................................................................
yes
no
State of the City
Annual Dinner & Auction
Membership Welcome
Newsletter
Home & Business Showcase
Golf Outing
Fundraising
Please use this space to describe your business for your Member Profile.
I attest to the best of my knowledge that the above information is true and correct.
Please enter Initials in the following box:
GBGCoC, City Hall, 802 Main Street, Beech Grove, IN 46107
www.gbgcoc.org
317.803.9109