Membership Application
Florida Puerto Rican/Hispanic Chamber of Commerce, Inc. (FPRHCC)
"Bridging the Future of our Business Community."
2293 Aurora Road Melbourne, Florida 32935
Fax 321-775-3996 Cell 321-863-5165 Cell 321-890-5827
Web Site: www.fprhcc.org
Email: info@fprhcc.org
Date *
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Company Name *
Your answer
Company Rep (Mr./Mrs./Ms.) *
Your answer
Position *
Your answer
Physical Address *
Your answer
City, State, Zip *
Your answer
Mailing Address if different from above
Your answer
City, State, Zip *
Your answer
Phone ( ) *
Your answer
Fax ( )
Your answer
Email Address *
Your answer
Web Page Address:
Your answer
Additional Company Information: Business Category *
Your answer
Type of Ownership :Check all that apply or type in another option *
Required
Number of Employees / Members *
Your answer
Description of Services or Products *
Your answer
Are you willing to offer a discount to FPRHCC Inc. members *
If you are offering a discount, how much?
Your answer
Minority Business? *
If your business is a Minority Business, are you certified?
Membership Fees and Levels: please choose one: *
Committee and/or committees I wish to serve on (Check all that apply) *
Required
Signature (Please type in your first and last name) *
Your answer
Date *
MM
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DD
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YYYY
Referred by:
Your answer
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