Member Application

Thank you for you interest in joining the Hispanic Chamber Cincinnati USA. For New Members, please complete the information below to start the application process. Under the Membership menu you will find the benefits and the oppotunities you will receive as member of HCCUSA.

Business Information

Company Name: *

Leave Blank:

Phone: *

Employees:

Full-time Part-time

Comments / Questions:

INDUSTRY PROFILE:

MINORITY OWNED: *

HISPANIC OWNED: *

COUNTRY OF ORIGIN: *

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Corporate Partner: $5,000.00
See Benefits Page Platinum: $1,300.00
See Benefits Page Gold: $850.00
See Benefits Page Silver: $400.00
See Benefits Page Bronze: $250.00
See Benefits Page Individual : $75.00
See Benefits Page Student: $25.00
See Benefits Page

Payment Option:

Bill me Charge my credit or debit card

Print Application