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Thank you for your support of the Ashland Chamber of Commerce

We deeply appreciate your membership.

Due to COVID-19, we understand some of our members may need flexible options to pay dues this year. In response, we created the options below.

I would like to pay dues as follows: (enter numbers only, no symbols)

	Annual Dues 2021-2022 One full payment
	Quarterly Dues 2021-2022 (Annual / 4) Pay my dues quarterly
	Monthly Dues 2021-2022 (Annual / 12) Pay my dues monthly
	Advance Dues (2022-2023) Add Advance dues
Additionally, we have had some requests to include opportunities to donate to support lighting the town for the holidays, to continue the flower basket program, or support overall programs.
	Light the Town for the Holidays Add contribution to light the town for the holidays
	Overall Program Support Add contribution for overall program support
	2022 Flower Basket Program Add contribution for 2022 Flower Basket Program

Sub-Total: $0.00

Total: $0.00

Please enter your information below ( * indicates required field )

BILLING INFORMATION

Payment Type: MasterCard Visa
Credit Card Number: *	Exp. Month: *	Exp. Year: *	Sec Code:
Checks can be mailed to : Chad Cota Athletic Foundation 711 Medford Center #141 Medford, OR 97504 In Kind payments must be pre-approved by the CCAF board. Please fill out and print this form print and enclose a copy of this form with your check.

Name (Name on card if using credit card)
*

Address: *
City: *
State: *	Zip: *
Phone: (555) 555-5555 *	Email: *

Ship To Billing Address:

SHIPPING INFORMATION

Ship To:
Address:
City:
State:	Zip:

Comments:

Thank you for your support of the Ashland Chamber of Commerce