Membership Application Name * Title * Company * Email Address * Address * City * Website State * Zip Code Work # * Cell # Year Founded * Geographic Work Area * Type of Work Performed * Business Formation * Sole Proprietorship LLC Partnership Corporation S Corporation Principals / Key Personnel & Title * Desired Reach Local Statewide Regional National Company Certification MBE WBE DBE Business Enterprise Program Section 3 8A Ageny Certification CMS Cook County City of Chicago MWRDGC IDOT CTA Metra WBDC Other Certificate of Ownership City of Chicago Cook County Illinois Department of Central Management Services (CMS) Public Building Commission (PBC) Illinois Department of Transportation (IDOT) Small Business Authority? (SBA) Chicago Minority Business Development Council (CMBDC) The ILBCC recognizes Self Certification as well as these Certifications Preffered Job Size Minimum Preffered Job Size Maximum Project References * Project Project References * Client Project References Project Project References Client Membership Catagories Gold Silver Platinum Sponsorship Catagories Sapphire Diamond Corporate Member's Pledge * I PLEDGE MY SUPPORT TO THE AGENDAS & ACTIVITIES OF THE ILLINOIS BLACK CHAMBER OF COMMERCE INCLUDING BUT NOT LIMITED TO: Joining & participating in one of the nine (9) Standing Committees, Attending & supporting the Annual Chamber “Lobby Day”in April, Attending & supporting the Annual Chamber “State Convention”, Supporting the Chamber’s Annual “Central Illinois Black Expo”, General support to the Chamber’s General Fundraising Efforts. To the best of my knowledge, the information on this application is correct and current. * Signature To the best of my knowledge, the information on this application is correct and current. * Date To the best of my knowledge, the information on this application is correct and current. * Sponsored/Referred By Submit If you are human, leave this field blank.