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Member Application
Thank you for joining the Gulf South LGBTQ+ Chamber of Commerce. Please complete the form below.
Business Information
Company Name:
*
Leave Blank:
Phone:
*
Website:
Email:
*
Business Description (200 char max):
*
Directory Category:
*
--- Select Primary Category ---
Accountants
Advertising/Promotions
Agriculture
Antiques/Estate Sales/Consignments
Apartments
Architectural Design & Building
Art Galleries
Arts & Crafts
Assisted Living
Attorneys
Automotive
Banks & Credit Unions
Beauty Salons/Spas
Books & Stationery
Car Rentals
Carpets & Interiors
Childcare
Childrens Clothing/Toys
Chiropractors
Churches
Cleaning Services
Clothing/Shoes
Community Organizations
Computer Service/Sales
Construction Management
Consultants
Contractors
Counseling
Country Clubs
Dance
Dental
Drug & Variety Stores
Dry Cleaners
Education
Elected Officials
Entertainment
Event Planning
Financial & Investment Services
Fishing
Fitness
Florists
Food & Beverage/Catering
Forestry
Funeral & Cremation Services
Gifts & Specialty Items
Government
Graphic Design
Grocery Stores
Hardware
Holistic Health
Home Furnishings
Hospitals & Clinics
Hotels/Motels
Human Resource Services
Insurance
Interior Design
Jewelry
Landscaping
Legal Services
Liquor Store
Mail Services/Shipping
Manufacturing & Production
Marine Charters, Sales & Service
Marketing
Massage Therapy
Medical Supply
Medical, Dental & Nursing Care
Mortgage Banking
Office Furniture & Supplies
Optical Services
Personal Services
Pets
Photographers/Photo Finishing/Framing
Press/Publications/Radio
Printing & Typesetting Services
Property Leasing & Management
Public Relations
Real Estate Services
Resorts
Restaurants
Restaurants & Specialty Dining
Security Services
Shopping Centers
Signs & Banners
Sporting Goods
Storage
Tax Preperation
Taxi
Telecommunications
Title Services
Travel Agencies
Utilities
Veterinarians
Wholesale
Employees:
Full-time
Part-time
Business Keywords (enter a space between words):
Comments / Questions:
Referred by:
*
Physical Address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Mailing Address
Same as physical address
Line 1:
*
Line 2:
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Social Networking:
LinkedIn
Facebook
Primary Contact Information
First Name:
*
Last Name:
*
Title:
Phone:
*
Cell Phone:
*
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
LinkedIn
Facebook
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Belgium
Belize
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Ghana
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sweden
Switzerland
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Billing Contact Information
Same as Primary Contact
First Name:
*
Last Name:
*
Title:
Phone:
*
Cell Phone:
*
Fax:
Email:
*
Contact Preference:
Email
Phone
Login:
*
Password:
*
Social Networking:
LinkedIn
Facebook
Address
Same as Member Address
Line 1:
*
Line 2
City:
*
State:
*
Postal Code:
*
Country:
*
--- Select Country ---
Canada
United States
Membership Options
Membership Package:
*
Student
:
$25.00
Membership for high school and college students
Individual/Non Profit
:
$100.00
Membership for non-business-owner freelance workers, employees, or those in employment transition. Also for Non Profit partners.
Small Business
:
$200.00
Membership for companies with 1-20 employees.
Medium Business
:
$400.00
Membership for companies with 21-100 employees.
Large Business
:
$800.00
Membership for companies with 101+ employees.
Silver Corporate Sponsorship
:
$1,000.00
Customizable online business directory profile, recognition as a sponsor at all chamber events, logo on homepage, logo in newsletter, discounted job postings on website, opportunities to post coupons or discounts on your products or services.
Gold Corporate Sponsorship
:
$2,500.00
Customizable Online Business Directory Profile, Recognition as a sponsor at all chamber events, Logo on homepage, Logo in newsletter, Discounted job postings on website, Opportunities to post coupons or discounts on your products or services. Co-Host one bi-monthly lunch and learn at no costs, with opportunity.
Platinum Corporate Sponsorship
:
$4,000.00
Customizable online business directory profile, recognition as a sponsor at all chamber events, logo on homepage, logo in newsletter, discounted job postings on website, opportunities to post coupons or discounts on your products or services, table setup at quarterly chamber events. Co-Host, at no additional cost, bi-monthly Networking Event (every other third-Thursday). One member of our Board will provide company-wide, on-site diversity training.
Payment Option:
Charge my credit or debit card
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