P.O. Box 57972
Jacksonville, FL 32241
Email > fchcc@comcast.net

Membership Application

I. Business Information:

Applicant Name:
 *required

Company Name:
Applicant's Title:
No. of Employees:
Type of product / service:
Are you a certified diverse-owned business?: Yes
No
If yes, which organization provided your certification?:
Address:  *required

City:  *required
State:  *required
Zip:  *required
Business Phone:  xxx-xxx-xxxx

Ext.
Business Fax:
Email for Contact Person:  *required
II. Volunteer for FCHCC Committees
Would you like to be active and involved in some of the projects on which we are currently working? Please choose a committee in which you would like to serve:
1) Education
2) Gov. Affairs
 3) Programs
4) Membership
III. Agreement

Membership Levels: *required

$1,000 Major Corporation Membership1
$200 Small Business/Corporation Membership2
$70 Individual3
Free Student

[ Credit Card/PayPal processing fee: 1$29.30, 2$6.10, 3$3.00 ]

Please select how you would like to pay: *required if not a Student
Credit Card & Paypal
              (a processing fee will be added)
Check

If paying by check, please submit
payment to:

FCHCC
PO Box 57972
Jacksonville, FL 32241

I agree that upon acceptance to the Association, I will abide by its by-laws and any amendments adopted during my membership and will promote its Mission Statement.
IV. FCHCC Membership Committee

It is the responsibility of the Membership Committee, to assist in the education, growth and perpetuation of the membership of FCHCC. They are charged with the duty to review and verify applications made to our association. It is the duty of the Membership Committee to make recommendations on applications to the sitting Board of Directors of the association, as to the factual worthiness of the application.

It is not the duty of the membership Committee to accept or reject applications. It is however, their duty to notify the Board in the event that there is no opening within the Classification requested for the application.