1. P.O. Box 4423, San Rafael, CA 94913 (415) 721-9686 www.hccmarin.com
Federal ID # 68-0328196
MEMBERSHIP APPLICATION
Thank you for your interest in joining the Hispanic Chamber of Commerce of Marin.
Your membership and participation will play a vital role in supporting the Hispanic Chamber of
Commerce of Marin's mission and objectives. We thank you for endorsing our efforts to
promote the success of Latino/Hispanic businesses and business professionals in our community.
Please choose from the following Membership Categories and complete the application on the
reverse side.
Membership Categories
 Individual Professional/Business Owner
(0 employees) $ 75.00
 Small Business (2-10 employees) $ 125.00
 Midsize Business (11-25 employees) $ 175.00
 Large Business (26-50 employees) $ 250.00
 Corporate - Silver (51+ employees – local) $ 350.00
 Corporate – Gold (51+ employees – national $ 500.00
or parent company)
 Student with ID $ 25.00
 Senior (65+ years) $ 25.00

2. MEMBERSHIP APPLICATION
Main Contact Name: ____________________________________Title: _________________
Company: _____________________________________________________________________
Address: ______________________________________________________________________
City: _____________________________ State: _________ Zip Code: ___________________
Phone __________________________ Ext. ________ Cell: ____________________________
Fax: ___________________________ Email: _______________________________________
Company Website: _____________________________________________________________
Are you on: Twitter Yes ___ No ___ Facebook Yes ___ No ___
Please make check payable to: Hispanic Chamber of Commerce of Marin
P.O. Box 4423, San Rafael, CA 94913
These items are attached with this application
____ Business Card ____ Brochure or Other Marketing Materials
Additional Information about You:
How did you find out about HCCM?
 Friend/Colleague
 HCCM Member - Name: __________________________________________
 HCCM Board Member - Name: _____________________________________
 HCCM Event
 Newspaper/Advertisement
 Other - _________________________________________________________
I prefer to receive Chamber information via:
 Snail Mail
 Email
I would like to attend
 After Work Mixers - Monthly _____ BiMonthly _____ Quarterly _______
Twice a Year ______
 Breakfast Training/Workshops – 7:30-9:00 a.m.
 Lunchtime Business Development Presentations
 After Work Business Development Training/Workshops
I am interested in advertising on the Chamber website and/or news eblast Yes ___ No ___
I am interested in joining an Affinity Group or Committee of the Chamber Yes ___ No ___