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Calendar GHCC Vendors
Event Payment/ReservationEvent Payment/Reservation
annual

 
 

 

  

General Information:  
Company Name: A value is required.
Address:
Suite #:
City:
State:
Zip Code:
County:
Telephone:
Fax:
Cell:
Website address:
Email address: A value is required.Invalid format.

Contact Information:  
Primary Contact: A value is required.
Title:
Address:
Suite #:
City:
State:
Zip Code:
County:
Telephone:
Fax:
Cell:
Email address: A value is required.Invalid format.

Additional Contact: A value is required.
Title:
Address:
Suite #:
City:
State:
Zip Code:
County:
Telephone:
Fax:
Cell:
Email address: A value is required.Invalid format.

Additional Contact: A value is required.
Title:
Address:
Suite #:
City:
State:
Zip Code:
County:
Telephone:
Fax:
Cell:
Email address: A value is required.Invalid format.

Additional Contact: A value is required.
Title:
Address:
Suite #:
City:
State:
Zip Code:
County:
Telephone:
Fax:
Cell:
Email address: A value is required.Invalid format.

MEMBERSHIP CATEGORIES (yearly rate): Membership begins on the joining date
Platinum $2,500 5 Corporate Representatives
Gold $1,500 4 Business Representatives
Silver $1,000 3 Business Representatives
Bronze $500 2 Representatives
International $200 1 Representatives
Single $100 1 Representatives
Non-Profit $100 1 Representatives
Student $25 1 Representatives

OTHER INFORMATION: This information is used by the GHCC staff to assist with business/vendor opportuni- ties, and to assist us with business development programming and services.

Is this a Hispanic owned business? Yes No

Date your business was established

Why did you join?

Type of Business:

Narrative Description of Company:

Referred by:

What is your business industry NAICS / SIC code(s)?
NAICS:
SIC:
www.naics.com / www.osha.gov/pls/imis/sicsearch.html

How many employees do you have?

What is the gross annual revenue of your company?

Do you conduct business outside of the U.S.? Yes No
If ‘yes’, where?

Is your business certified? Yes No
If ‘yes’, what certifications? (ie: MBE, WBE, City of Atlanta, etc)
MBE:
WBE:
DBE:
HBE:
Other:

PAYMENT INFORMATION: Please make checks payable to GHCC

Credit card payment option:
Visa
MasterCard
Discover
American Express

Credit card #:
Expiration date:
V-code:
Name of cardholder
Signature:

  

 
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