2021 New Member Form

Member Information as he/she has been listed on FACC-Chicago's Directory

* Company (For Individual & YP Members: Your company will NOT be listed. Please write 'N/A').
* First Name:
* Last Name:
* Email Address:
* Confirm Email Address:
* If you are not the entitled member, but you are the person handling this account, please provide your Name, Email and Phone (If not applicable, write down "same as above")
characters remaining
* Please list the primary contact's nationality/ies:

Type	Fee
BENEFACTOR	$3,000.00
BOARD MEMBER	$1,550.00
LARGE CORPORATE ( 100+ employees)	$750.00
CORPORATE ( 3-99 employees)	$550.00
SMALL CORPORATE ( 1-2 employees)	$350.00
NON-PROFIT / GOVERNMENT / EDUCATION	$250.00
INDIVIDUAL	$200.00
YOUNG PROFESSIONALS (*35 years old or under only*)	$85.00

*
To qualify as a Young Professionals Member, you must be 35 years old or younger at time of registration. Do you confirm that you are 35 years old or younger?
- Yes, I am 35 years old or younger and qualify for YP Membership.
- Not applicable - I did not select the YP Membership level.