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Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Information Referred By Required Please enter a valid number Please enter a valid date Please enter valid credit card information Sponsor Required Please enter a valid number Please enter a valid date Please enter valid credit card information # of Employees Required Please enter a valid number Please enter a valid date Please enter 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General Member Trustee Trustee Platinum Chairman's Circle Primary Directory Category None Advertising, Marketing, PR & Production Agriculture, Fishing & Forestry Arts, Culture & Entertainment Bars, Nightclubs and Nightlife Business & Professional Services Catering & Event Services Communications Community, Family & Civic Organizations Computers, IT & Technology Construction Equipment & Contractors Finance & Insurance Government, Education & Individuals Health Care Home & Garden Industrial Supplies & Environmental Services Legal Lodging, Travel & Tourism Moving & Storage Other Personal Services & Care Public Utilities & Environment Real Estate Religious Organizations Restaurants, Food & Beverages Shopping & Specialty Retail Sports & Recreation Transportation, Automotive & Marine Services Wholesale Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Total The contents of this box are for testing purposes. 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Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 2 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 3 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 4 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 5 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 6 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 7 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 8 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 9 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 10 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Revenue Item Required Please enter a valid number Please enter a valid date Please enter valid credit card information Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Temp Value For DropDown 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information MembershipType Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Number of Full Time Employees Number of Part Time Employees Number of Rooms Number of Seats Number of Associates Number of Locations Millions in Assets Annual Membership Investment Additional Items Additional Categories Cost One-Time Application Fee Tax Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. 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Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaAmex Credit Card Number Required Please enter a valid number Please enter a valid date Please enter valid credit card information Name on Card Required Security Code Required Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Address Required City Required State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Phone Required Credit Card Email Address I understand that by providing my mailing address, email address, telephone number, and fax number, I consent to receive communications sent by or on behalf of Greater Miami Chamber of Commerce via regular mail, email, telephone, or fax. 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