Corporate Membership Application

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Corporate Regular: $1000.00
Registration Fee: $100.000
Total Due: $1100.00
*Company may bring any TWO guests to each meeting, including the Annual Dinner meeting.

Corporate Elite: $2500.00
Registration Fee: $100.000
Total Due: $2600.00
*Company may bring FOUR people to each meeting including the Annual Dinner Meeting. Reserved Seating may be requested.

Which Corporate Membership? *

Corporate Regular

Corporate Elite

Name of Corporation

Primary Contact Name *

Primary Contact Email *

Corporation Address *

Phone number

Additional Corporate Members

Preferred Invoicing Choice

Paypal/Credit Card (will be sent upon application being received)

Send Check: 1620 Crescent Ridge Road, Daytona Beach, FL 32118

Clear selection

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