P.O. Box 4423, San Rafael, CA 94913 (415) 721-9686 www.hccmarin.

com
Federal ID # 68-0328196 HCCM is a 501(c)6 Tax-exempt Corporation

MEMBERSHIP APPLICATION
Thank you for your interest in joining the Hispanic Chamber of Commerce of Marin. Your
membership and participation will play a vital role in supporting the Hispanic Chamber of Commerce of
Marin's mission and objectives. We thank you for endorsing our efforts to promote the success of
Latino/Hispanic businesses and business professionals in our community.
The Hispanic Chamber of Commerce of Marin has several levels of membership based on company size.
All membership levels include the following basic benefits:

Member discounts for tickets to Hispanic Chamber events and programs, including our annual
signature events (Mujer Latina Luncheon, Cinco de Mayo, Christmas La Posada Celebration)
Eligibility to join a Committee or Affinity Group
Eligibility to be nominated for the Hispanic Chambers community and business awards
Eligibility to be nominated for business awards associated with other organizations (e.g. Spirit of
Marin Award, Telemundo Business Salute, MBDC Award, SBA Awards)
Access to free webinar trainings through our affiliation with the California Hispanic Chambers of
Commerce.
Access and discount tickets to Annual Conferences of the California Hispanic Chambers of
Commerce and United States Hispanic Chamber of Commerce.
Access to business seminars and programs designed to develop your business and make your
employees more productive, through our partnerships with SCORE, SBDC, Renaissance Center
and Marin Employment Connection
Ribbon cutting ceremony at opening of a new business
Opportunity for your company sponsorship at many Hispanic Chamber events
Participation in County-wide Networking events sponsored by the Marin Council of Chambers
Promotional opportunities on the Hispanic Chambers website, e-blasts and social media
announcements (Facebook, Twitter, Linked In)
Hispanic Chamber membership certificate
Company listings on the Hispanic Chamber website (under construction)
Job Postings on the Hispanic Chamber website (under construction)

Membership Categories: Please choose from the following and complete the application (pg 2).

Individual Professional/Business Owner
(0 employees)

Small Business (2-10 employees)

Midsize Business (11-25 employees)

Large Business (26-50 employees)

Corporate - Silver (51+ employees local)

Corporate Gold (51+ employees national or parent co.)
Individual community categories (not associated with a company):

Student with ID

Senior (65+ years)

$ 75.00
$ 125.00
$ 175.00
$ 250.00
$ 350.00
$ 500.00
$ 25.00
$ 25.00

Hispanic Chamber of Commerce of Marin - Membership Application

NEW ___

RENEWAL___

Page 2

Date Application Completed ______________(m/d/yr)

MEMBERSHIP APPLICATION
Main Contact Name: ____________________________________Title: _________________
Company: _____________________________________________________________________
Address: ______________________________________________________________________
City: _____________________________ State: _________ Zip Code: ___________________
Phone __________________________ Ext. ________ Cell: ____________________________
Fax: ___________________________ Email: _______________________________________
Company Website: _____________________________________________________________
Are you on:

Twitter Yes ___ No ___

Facebook Yes ___ No ___

Please make check payable to: Hispanic Chamber of Commerce of Marin

P.O. Box 4423, San Rafael, CA 94913

Amt Encl:$__________

Credit Card Payment: VISA MC Discover Am Exp

Name on Card: ______________________________________________ Amount $______________
Card # _____________________________________________________ Exp. Date _____________
Billing Zip Code ____________________

3-4 digit Sec Code ______________________

Please contact us if you need a W-9 form to complete your dues payment 415-721-9686.
HCCM Federal ID # 68-0328196 - HCCM is a 501(c)6 Tax-Exempt Corporation. Your Annual Membership Dues
may be tax-deductible as a business expense. Please consult with your tax professional.

Additional Information about You:

How did you find out about HCCM?
___ Friend/Colleague
___ HCCM Member - Name: __________________________________________
___ HCCM Board Member - Name: _____________________________________
___ HCCM Event ___ HCCM Facebook ___ HCCM Twitter
___ Linked In ___ Google
___ Newspaper/Advertisement
___ Other - _________________________________________________________
I prefer to receive Chamber information via:

___ Snail Mail ___ Email

I would like to attend

___ After Work Mixers - Monthly ____ Bi-Monthly _____ Quarterly _______ Twice a Year ______
___ Breakfast Training/Workshops 7:30-9:00 a.m.
___ Lunchtime Business Development Presentations
___ After Work Business Development Training/Workshops
I am interested in advertising on the Chamber Website and/or News E-Blast
I am interested in joining an Affinity Group or Committee of the Chamber

Yes ___ No ___

Yes ___ No ___