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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 Gross Income (million $) $0-1 $1- 2-5 $2.5
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 2015
PLEASE NOTE:

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

Annual dues are pro-rated. Contact us for correct amount.

Category Annual Corporate
Gross Income
Initiation Fee
(Nonrefundable)
Annual Dues 2015 Representatives Allowed
A $2.5 million $175 $1.995 8
B $1 - 2.5 million $175 $1.612 6
C $500.000 - 1 million $175 $1.123 4
Small Business
& Non-Governmental Organization

Up to $500.000

$175 $790 2
IND Individuals $175 $468 1

Name of Applicant
( please print )
Signature

 

 

 

ENOSH, S.A. (Grupo Golan)
WHIRLPOOL CENTRO AMERICA
AEROBELL AIR CHARTER
ELECTROTECNICA S.A.
GRUPO NITIDOS
CARPET WORLD INT S.A.
TECNOLOGIA ACCESO & SEGURIDAD TAS S.A.
HOTEL FINCA PANGOLA LTDA. / (Cinco Ceiba)
LATCO TRUST AND ESCROW
D&PL SEMILLAS LTDA