CYP Enrollment Form

Please Print Legibly.

Name_____________________________________________
Company Name____________________________________
Job Title___________________________________________
Preferred Mailing Address___________________________________
City_______________ State____ Zip____________
Primary Telephone # ___________________ Circle: cell home bus.
Fax #:________________________ Email: ___________________________
Date of Application ___________

Chamber Member (Free) ____ One Year Membership ($50) ____

Payment Options
___Check ___Credit Card
___Mastercard ___Visa ___AMEX ___Discover
Credit Card Number______________________________________________
Expiration Date: _____ Signature_________________________________

You will receive a call to verify registration and obtain your 3-digit
credit card security code.

All cost-related events and meetings of CYP are the personal

responsibility of the CYP member. All costs are payable and due at

connect
the time of the event. The Chesterfield Chamber will not bill
companies for costs incurred.

Return Payment and Enrollment form for membership approval.

Checks made payable to:
emerge Chesterfield Missouri Chamber of Commerce
101 Chesterfield Business Parkway, Chesterfield MO 63005
c hesterfield young professionals
lead

Enrollment Approval Date__________ Representative____________

Chesterfield Chamber
sponsored by
 c hesterfield young professionals
connect emerge lead

about CYP membership

getting involved
mission statment: to provide an avenue for
young professionals to increase their business
and social network, engage in professional
development and grow through community
service opportunities.

connect emerge lead