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MID-ATLANTIC - EURASIA/RUSSIA
BUSINESS COUNCIL
MEMBERSHIP APPLICATION

Print this form and fill it out

Corporate & Company Memberships
Please Check Applicable Line:
Annual Dues, payable in advance, are based on annual revenues:
Gross SalesDues

___1.Up to $25 Million$250
___2.$25 - $100 Million$450
___3.Over $100 Million$950
___4.Corporate Sponsorship$2000

Non-Profit organization
A flat fee of $100 per year.

Company Name:____________________________________
Type of Business:________________________________
Contact:_________________________________________
Title:___________________________________________
Street Address:__________________________________
City, State, & ZIP:__________________________
Telephone:__________________Fax:_________________
E-mail:__________________________________________
Websait:_________________________________________
Applicant's Signature:___________________________

Please mail application and check to:
Mid-Atlantic - Eurasia/Russia Business Council
1600 Market Street, Suite 1320
Philadelphia, PA 19103


Cultivating Economic and Cultural Partnerships
between the U.S. Mid-Atlantic States and Eurasia/Russia