Business Name: ______________________________________________________________________
Contact Name: _______________________________________________________________________
Title: _______________________________________________________________________________
Business Category: ____________________________________________________________________
Telephone: __________________________________________________________________________
Cell: ___________________________________________Fax: _________________________________
Street Address: ______________________________________________________________________
City: ____________________________________State: ________________Zip Code: ______________
Email: _____________________________________WebSite: _________________________________
ANNUAL MEMBERSHIP PACKAGE (Please select the level of membership for your business
Non Profit: $475
Friend: $1,000
Booster For African Business: $2,000
Supporter: $3,500:
Trade / Commerce: $4,500
Leadership Circle: $5,000
Corporate: $10,000
What year was your company established: ________________________________________________
Description of your business: __________________________________________________________
Under 10 Employees
Under 20 Employees
Under 50 Employees
Under 75 Employees
Under 100 Employees
100 + Employees
What other professional organizations do you belong to, if any? ____________________________________
Please confirm your partnership by signing below and faxing this page to: Fax: 212-202-5357
Name: (Please print): ___________________________________________________________________
Accepted By: ____________________________________________________Date: _________________
(i.e Network in USA, in Africa, Import/Export, Investment,
Commerce / Trade, Representation, Spread word about my business), Access to resources {Finance, HR, Staffing}, Advocacy issues, etc...
Allied African Nations
CHAMBER OF COMMERCE
575 Madison Avenue 10th Floor
New York, NY 10022
Tel: 212-937-8461 Fax: 212-202-5357
www.africanationschamber.com