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MEMBERSHIP INFORMATION

How to join the Chamber

MEMBERSHIP APPLICATION
Please complete the membership application form in full. Uncompleted forms cannot be submitted for consideration.

Please fill out (print/type) clearly the following information in english.
GENERAL INFORMATION
Date
 Company Name
Nacionality
U.S. Costa Rican Other
Phone
 Fax
E-mail
 Web Site
P.O. Box
 Local Address
Type of Business
 Date of Incorporation
Nº of Employees
Solidarity Association  yes no

Operations in other countries

Annual Corporate $0-1 $1- 2-5 $2.5

Gross Income (million $)
COMPANY'S BOARD OF DIRECTORS NAMES AND TITLES
1.
2.
3.
4.
AMCHAM MEMBER REFERENCES
(include specific person to be contacted)
1. Name
 1. Company
2. Name
   2. Company
3. Name
 3. Company
NAMES AND TITLES OF OFFICERS AUTHORIZED TO ATTEND MEETINGS AND PARTICIPATE IN AMCHAM ACTIVITIES
(Number of representatives depends on membership category,
see back or application)
1. Name
 1. Title
1. Email
  
2. Name
 2. Title
2. Email
  
3. Name
 3. Title
3. Email
  
4. Name
 4. Title
4. Email
  
5. Name
 5. Title
5. Email
  
6. Name
 6. Title
6. Email
  
7. Name
 7. Title
7. Email
  
8. Name
 8. Title
8. Email
  
FOR U.S. COMPANIES
HEADQUARTERS
(If Applicable)
Nº of Employees
 Company Name
Address
 City
Phone
 Fax
E-mail
 Web Site
BANKING AND COMMERCIAL REFERENCES
1.
2.
3.
4.
MEMBERSHIP CATEGORIES
PLEASE NOTE:

The membership category is determined by AmCham and in accordance with the company ’s annual gross income and its corporate profile.

Category Annual Corporate
Gross Income
(Your company’s
gross income)		 Initiation Fee Annual Dues 2010 Individual Representatives Allowed
A $2.5 millions $175 $1.500 8
B $1 - 2.5 millions $175 $1.235 6
C $500.000 - 1 million $175 $885 4
SB

Up to $500.000
(Small Business
& Non Governmental Organizations)

 $175 $650 2
IND Individuals $175 $395 1

Name of Applicant
( please print ) 		Signature
 

 

 

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