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Online Membership Form

Please fill out the following information as completely as possible. When you are finished, click the submit key to complete your registration. Once we receive your registration information, we will send you an invoice for your selected membership level. Or, if you prefer, print out this completed page and mail or fax it to our office with payment:

CEPCO
555 Main St. Suite 200
Chico, CA 95928
Fax: (530) 892-8197

Membership Information

Membership Type:

Advocacy Member - $5000 Executive Member - $1000 Basic Business - $500 Individual or Home-Based - $250

I am interested in:

Participating on a Committee Participating on the Board of Directors (Executive Members Only) Name:
Title:
Company:
Type of Business:
Number of Employees: Street Address:
Mailing Address: (if different)
City: State: Zip: Telephone:
Fax:
Email:
Website:
Method of Payment: Invoice Visa Mastercard Additional comments: (questions, comments, new member referrals)