Name*:           Spouse Name:         Profession:        E-Mail Address:           Address*:              City*:            State/Zip*:               Firm:       Firm Address:               City:             State/Zip:            Tel(H)*:                   (W):             Fax(H):                   (W):   Type of Business:    Product/Service:    Reference By(1):                (2):   Application Date:                                                 

 **The fields which has * is required fields. **Membership Fee:$200 (CoveRs from July 1st to June 30th next year, 
   including dinners of six meetings per year.) **The couple could apply separately.One member only from each family 
   can serve on  the board of the directors. **Please make the payment to: Taiwanese Chamber of Commerce of Greater Detroit.