Membership Categories
Associate Member        $450   (individuals only)
Regular Member           $2,500
Sustaining Member        $5,000
Benefactor Member      $8,750

Application for Membership
The company, organization, institution or law firm listed below seeks membership in the
U.S. - Azerbaijan Chamber of Commerce (USACC) and wishes to receive all of the benefits
available to its fully paid members in good standing. Please consider me for participation as:

Fully paid member in good standing
I would like to help in the following ways:

___________________________________________________________

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Name:_____________________________________________________

Title:______________________________________________________

Company:__________________________________________________

Address: ___________________________________________________

City:________________________State:________Zip:_______________

Telephone:_________________________

Fax:_______________________________

E-mail:_____________________________

Membership Level: ______________________________________

Date:______________________________________

Signature:_________________________________