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TO MAIL IN THIS APPLICATION SEE THE BUTTON ON THE BOTTOM RIGHT SIDE THAT ALLOWS YOU TO PRINT THIS APPLICATION.
TO FAX THIS APPLICATION FOLLOW THE DIRECTIONS ABOVE AND SEND TO
(954) 523-0607
THIS APPLICATION MAY ALSO BE COMPLETED ONLINE AT Interested in Joining. |
Marine Council Application
Company Name________________________________________________________
Primary Representative Name & Title: ________________________________________________________________________
Sponsor: ______________________________________________________________
(Name and Company)
Must be a member in good standing
Company Description _________________________________________________
________________________________________________________________________
________________________________________________________________________
Products & Services: __________________________________________________
________________________________________________________________________
________________________________________________________________________
Years in business:_______ Number of employees _______
Annual Revenue: _________________
Address________________________________________________________________
City, State, Zip ________________________________________________________
Business Phone ______________________ Fax ____________________________
Cell ______________________
Primary Email ________________________________________________________
Secondary Representative & Title: ___________________________________
Secondary Email _____________________________________________________
Company Website ____________________________________________________
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Today's Date: Payment Method:
*Visa, Master Card & AMEX
Expiration Date: 3 or 4 digit Security Code on Back: Billing Zip Code:
Name as it appears onCard: Signature:
Membership Investment: $
One Time Admin. Fee: $ 40.00*
*New Members Only
Investment Total: $ |
Make checks payable to the Marine Council
1825 Ponce de Leon Blvd., #412 * Coral Gables, FL 33134-4418
786-586-4688 phone
305-270-9600 fax
www.miamimarinecouncil.com
email: kitty@miamimarinecouncil.com