GSCCC Membership Application
Company Name:
Main Contact:
Title:
E-Mail:
In Business Since: (date or year)
Physical Address:
City/State/Zip:
Mailing Address:
City/State/Zip:
Company Main Phone:
Company Main Fax:
Company Web Site URL:
Business Categories:

Other people who should receive information
Name:
Title:
E-Mail:
 
Name:
Title:
E-Mail:

GSCCC Investment Schedule
Please note: There is an initial set up charge of $25.00 that will be added to all new memberships. This is a one time fee.
Number of Employees: Full Time    Part Time  
 Plan 1: Hospitals, Nursing Homes
$7.00 per bed
Number of Beds
 Plan 2: Hotels / Motels
$5.00 per room
Number of Rooms
 Plan 3: Professionals
First two professionals: $200.00 / $50.00 each additional
Number of Professionals
 Plan 4: Associate Members
Retired Business Owner: $100.00
 Plan 5: Financial Services
(Realtors, Insurance Agents, Financial Planners)
First three agents: $200.00 / $15.00 each additional agent
Number of Agents
 Plan 6: Financial Institutions (Banks / Credit Unions)
Base of $500.00, plus $20.00 per $1,000,000 on deposit
Total Deposits
 Plan 7: Nonprofit Organizations 501 (c) (3)
$150
 Plan 8: Individual
$150
 Plan 9: Other Businesses (Number of Employees)
1 to 5 $175.00 21 to 30 $300.00 51 to 100 $550.00
6 to 10 $200.00 31 to 40 $350.00 101 to 150 $675.00
11 to 20 $250.00 41 to 50 $425.00 151 to 200 $800.00
201 and above $800.00 plus $2.00 per employee
Additional Sponsor Opportunities (Contact Us)
Gold Founding Sponsor: $5,000.00 to $9,999.00
Diamond Founding Sponsor: $10,000.00 to $19,999.00
Platinum Founding Sponsor: $20,000.00 and up
Please select the main reason(s) for joining the ESCCC
 Business Assistance & Advice  Marketing Opportunities
 Directory Listing / Referrals  Education / Training
 Networking Opportunities  Supporting the Community
 Legislative Advocacy  Other 
May we add your name to mailing lists we sell?
 Yes    No
May we list you in our online member directory?
 Yes    No
Would you like to participate in our Member to Member Discount Program?
Yes, what percentage discount will you offer to ESCCC members