Date __________________________________

Business Name __________________________

Contact Name   _________________________

Street Address  _________________________

City ___________________________________

State/Zip   _____________________________

Phone (work) ___________________________

Phone (optional)  ________________________

Fax ___________________________________

Email    ________________________________

Website _______________________________

Referred By (optional) ____________________

 Annual Membership Fee $80.00 ___________

 Supporting Member Fee $40.00  __________
 (Retired/Non Profit)

 I am very interested in volunteering on the
 following committees (Please check all that apply):

 Membership  __

 Public Affairs  __

 Fund Raising  __

 Finance  __

 Event Planning  __

 Business Development  __

 Other Interests or suggestions

______________________________________

This form must be included with payment!  Please make check payable to:
Peninsula Chamber of Commerce
and mail to:
Peninsula Chamber of Commerce
PO Box 6015, San Diego, CA 92166

Membership Questions?  Please call 619.225.6665 or email tanderson@sdtg.com