WHCC Membership Application
The following application is for new and prospective members of the Wichita Hispanic Chamber of Commerce. To pay membership dues online, please visit http://www.wichitahispanicchamber.org/#!shop/c1yq0. For questions, please call, 316-265-6334
1. Membership Information- Primary Contact
Is this application *
Membership Date *
Your answer
Full Name *
Your answer
Title *
Your answer
Company/Organization *
Your answer
Website *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Fax *
Your answer
Email *
Your answer
Number of employees *
Your answer
Type of business
Your answer
Products or Services?
Your answer
Principal Clients
Your answer
Is your company Hispanic owned and operated?
Is your company woman-owned and operated?
Ethnicity
2. Membership Levels
- Fees are on a yearly basis and membership levels are based on the size of the organization (number of employees)
- We allow membership levels a certain amount of representatives. These individuals are the Chamber's key contacts in order to make sure that all our members remain connected to WHCC activities, events and information
- The Wichita Hispanic Chamber of Commerce Inc. cannot give income tax advice. You should consult with a qualified tax adviser to determine the deductibility of any dues
- The Wichita Hispanic Chamber of Commerce Inc. is a 501(c)(6) non-profit organization
Individual Level - One representative
Non-Profit Organization - One Representative
Small Business Membership - Two Representatives
Corporate Partner
Second Representative
Corporate Partner Levels: Bronze, Silver, Gold and Platinum
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Third Representative
Corporate Partner Levels: Bronze, Silver, Gold and Platinum
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Fourth Representative
Corporate Partner Levels: Silver, Gold, Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Fifth Representative
Corporate Partner Levels: Gold and Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Sixth Representative
Corporate Partner Level: Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Seventh Representative
Corporate Partner Level: Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Eighth Representative
Corporate Partner Level: Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Ninth Representative
Corporate Partner Level: Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
Tenth Representative
Corporate Partner Level: Platinum only
Full Name
Your answer
Title
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone
Your answer
Fax
Your answer
Email
Your answer
3. Payment Method
4. Recruited by:
Your answer
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