Fillable Partnership Application

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Partnership Application

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The Partnership Application form is 4 pages long and contains:

  • 1 signature
  • 40 check-boxes
  • 52 other fields

Country of origin: OTHERS
File type: PDF

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_________________________________ __________ __________________________________________________
First Name
Middle Initial Last Name
_______________________________________________________________________________________________
Title
________________________________________________ ______________________________________________
Phone # with Extension Cell / Mobile #
E-mail
If you would like any of your employees to be added to the chamber’s e-mail distribution list, please list their e-mail addresses:
_______________________________________________ ______________________________________________
Name / Title
E-mail
_______________________________________________ ______________________________________________
Name / Title
E-mail
_______________________________________________ ______________________________________________
Name / Title
E-mail
_______________________________________________ ______________________________________________
Name / Title
_____________________________________________
Company Name
Year Established # of Employees
_______________________________________________ ________________________ ________ _____________
Mailing / Billing Address
City State Zip
Category
Referred By
o Woman-Owned o Minority-Owned o Veteran-Owned
o Service Disabled Veteran-Owned
o Nonprofit
The Space Coast's Leading Chamber for Business Advocacy and Community Development.
Please contact us at (321) 724-5400 or Partnership@MelbourneRegionalChamber.com with any questions.
COMPANY INFORMATION (All contact information required. Please list as you would like it to appear to the public.)
POINT OF CONTACT INFORMATION (Who will represent your company and receive information?)
Partnership Application
o Better Business Certified (BBC) Additional Annual Investment: $150
Provides a partner business with a clear identity for being reputable, trustworthy, and accountable. The BBC brand enhances a
partner business’s own brand through additional credibility and respect. Must have been in business for at least one year.
- Receive BBC partner recognition on digital online partnership directory and window cling to promote your company as
dedicated to the highest ethical standards
- Receive priority referrals
- Permission to use BBC logo
- Complimentary Melbourne Regional Chamber digital database ($150 value)
Councils are sub-groups of partners of the chamber, formed within the chamber, that focus on a particular niche or business area. When
these niche groups grow in the number of partners, the chamber creates a council (by directive of the Board of Directors). As the council
shrinks in partners, as they do from time to time, the board disbands the council. Partnership in some of the councils is included with
chamber partnership. Other councils have additional annual dues.
BENEFITS
JOIN A COUNCIL
Feel free to add additional pieces of paper with additional names.
_______________________________________________________________________________________________
______________________________________________________________ __________________ _____________
_____________________________________________
E-mail
1
o Business Advocacy Committee: Included with chamber dues. The Business Advocacy Committee lobbies for key issues that
impact Melbourne and Brevard County’s business community. Guided by our overarching mission statement as the Melbourne
Regional Chamber, the Business Advocacy Committee's focus is protecting the business-friendly climate of Melbourne, as we work
in conjunction with all the chambers across Brevard County.
o ENGAGE Young Professionals: Included with
chamber dues. Focused on career growth, professional
development, and
issues of interest to partners under the
age of forty, this council welcomes members of all ages.
o Nonprofit Council (NPC): Included with chamber dues.
Dedicated to providing nonprofit organizations with the tools
they need to succeed through leadership training,
information
sharing and review of best practices.
JOIN A COUNCIL OR COMMITTEE (CONTINUED)
o Viera Regional Business Alliance (VRBA): Included
with chamber dues. Dedicated to the growth and
concerns of the Viera/Suntree/Rockledge area, this
council is the place to be if you are doing business, or
want to be doing business, in those areas.
o Women of Excellence Council (WE):
Included with chamber dues. Gatherings to empower
diverse working women to achieve their highest potential
through collaborative initiatives focusing on networking
and professional development.
One Time Application Fee
Annual Better Business Certified Dues
Total Amount Due
= $
o Referral Group Additional Annual Investment: $40
Referral groups are tight-knit sub-groups within the chamber that meet frequently (usually twice a month) to share qualified
business referrals with other partners in their group. Because of their strict loyalty to their fellow group partners, only one
partner of each business type is permitted to be in each referral group. Referral group size is limited to 50 partners per group.
NOTE: Because of the unique nature and exclusivity of business type in each referral group, the referral group annual
investment of $40 is the only chamber investment that may be refunded for the first year. To receive a full refund, the partner
must attend one meeting of each of the chamber referral groups and be rejected partnership therein due to a business type
conflict (referral group already has a competing partner of the same business type). The referral group leader’s signature/date
serves as proof of attendance and rejection.
DUES AND OTHER INVESTMENTS
JOIN A REFERRAL GROUP
o Small Business Council (SBC): Included with chamber dues. Designed for businesses and organizations fewer than 50
employees. Council partners network, share information, and gather the resources they need to improve, grow and flourish.
Annual Partnership Dues
for a period of 12+ months (non-refundable)
$40 annual upgrade
$ 50.00
+$
$
Annual Referral Group
$150 annual upgrade
+$
METHOD OF PAYMENT
________
________
________
________
Dues payments to the Melbourne Regional Chamber are not deductible as a charitable contribution for federal income tax purposes. Dues payments may be deducted as an
ordinary and necessary business expense. You are advised to consult a tax professional regarding the deduction of dues payments to the chamber. With the exception of referral
groups, as explained above, dues and other investments paid to the chamber are non-refundable.
2
ONLINE INFORMATION (If you or your company is online, please link up with us.)
No
No
Do you have a website?
o
Facebook page?
LinkedIn?
Twitter?
Instagram?
Yes
Yes
Yes
No
Address
:
Page
:
Page:
Account:
Account:
No
Yes
Yes
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________
________
_______________________________________________________
________
No
UPON RECEIPT OF PAYMENT, WE WILL ANNOUNCE YOUR NEW PARTNERSHIP ON SOCIAL MEDIA AND IN OUR
NEWSLETTER. Please provide the following as you would like them to appear:
Brief description of your business (2-3 sentences):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Quote regarding why you are joining the Melbourne Regional Chamber.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Check Enclosed (Payable to Melbourne Regional Chamber, 1005 E. Strawbridge Avenue, Melbourne, FL 32901-4782)
Credit Card (See credit card authorization form on page 4. Partnership@MelbourneRegionalChamber.com)
Please send me an E-Invoice
Questions? Call (321) 724-5400 or email: Partnership@MelbourneRegionalChamber.com
FOR OFFICE USE ONLY
Rec’d by ____________________________________
Rec’d date ___________________________________
Payment type o
check check # ________________
ocredit card ocash/money order
Renewal date ________________________________
New Partner Number _________________________
Rev. 4/16/2021
3
Partnership Agreement: I agree to abide by the bylaws and policies of the Melbourne Regional Chamber. I acknowledge that my company may
use the chamber logo on all advertising, marketing, promotional, and public relations materials, which includes but is not limited to, the display of the
chamber partner w
indow cling, as long as my company remains a partner in good standing. Remaining a partner in good standing includes paying all
chamber bills, including partnership dues bills, within 30 days or less.
If my company’s partnership in the Melbourne Regional Chamber becomes inactive or is terminated for any reason, I agree to immediately
discontinue use of any and all chamber logos and insignias. I further agree that I will immediately remove from public display and viewing my
chamber partner window cling.
I understand acceptance into the chamber DOES NOT GUARANTEE acceptance into any endorsed program and / or affinity program sponsored by
the Melbourne Regional Chamber.
I agree that the Chamber Board of Directors has full and final authority as to whether my partnership will be accepted.
Signature of Company Primary Contact (required for partnership) ____________________________________________ Date________________
PARTNERSHIP AGREEMENT FOR ALL P
ARTNERS
CREDIT CARD INFORMATION
Credit Card Authorization Form
____________________________________________________________________________ _________________
Cardholder’s Name (as it appears on card)
Billing Zip Code
________________________________________________ ___________________________ _________________
Expiration Date
Security Code (on back)
Credit Card Number
_______________________________________________
Cardholder Phone Number
o Visa o Master Card
o American Express o Discover Card
PAYMENT FOR
o Certificate of Origin
oNew Partner/Investor Application
Relocation Packet
o Event _____________________________________________________ o Other ________________________________________
Amount $ __________________ Signature _________________________________________________ Date ______________________
Map
Notary
4
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Partnership Application

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Completed 14 May 2021

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