Membership Application

COMPANY INFORMATION

Company:

Description:

Web address:

Company type:

Annual revenue (US dollars):

Number of employees:

Industry:

PRIMARY CONTACT INFORMATION
The primary contact is responsible for coordinating the company's center membership, including managing the annual dues process.

Contact Name:

Title:

Street Address:

City:

State/Province:

Zip:

Phone:

Email:

PAYMENT

Please print this form and submit with payment. Make checks payable to Boston College-CCC.

If you prefer to be invoiced, please indicate here:
Please send invoice to the address above.
(If different address, please indicate under comments below.)

Comments:

Please tell us how you learned about The Center.

TERMS OF MEMBERSHIP

Membership begins immediately upon the approval of your application and lasts for 12 months. Approval will be communicated to you in an email.

Membership is a corporate membership, not an individual membership.

Membership dues are based upon the annual revenue of your company. As of January 1, 2006 dues are as follows:

Annual Revenue	Annual Dues
less than $1 billion	$2,000
$1 billion - less than $5 billion	$5,000
$5 billion - less than $7 billion	$7,500
$7 billion and over	$10,000

By submitting this application, I agree to pay the full membership dues within 30 days of invoice, and am responsible for renewal, cancellation, and updates of membership information for my organization.

I agree to the above terms.

You will receive confirmation of this request via email. If you do not receive confirmation within 48 hours, please call 617.552.4545.