17456 NW US HWY 19 FANNING SPRINGS, FL 32693

Office Location: 9890 Florida Ave. (Behind Huckleberry’s BBQ)

Ph 352-463-9089 FAX 352-463-7226

www.fanningspringsflorida.com e-mail: fanningspringsch@bellsouth.net

ANNUAL MEMBERSHIP FOR 2007

BUSINESS NAME______________________________________________________________

MAILING ADDRESS (P.O. Box or Street)___________________________________________

CITY, STATE__________________________________________________________________

BUSINESS LOCATION ADDRESS________________________________________________

TELEPHONE_________________________ FAX_______________________________

E-MAIL_________________________ WEBB ADDRESS____________________________

CONTACT PERSON____________________________________________________________

NUMBER OF EMPLOYEES______________________________________________________

PRODUCT OR SERVICE________________________________________________________

LARGE CORPORATIONS 100 OR MORE EMPLOYEES..............$100.00

SMALL BUSINESSES 99 OR LESS EMPLOYEES.........................$ 50.00

INDIVIDUALS/NON PROFIT ORGANIZATIONS..........................$ 25.00

MAKE CHECKS PAYABLE TO:

THE FANNING SPRINGS GREATER CHAMBER OF COMMERCE

X___________________________________ DATE________________________

SIGNATURE

PLEASE REMIT DUES NOW!! THANK YOU