FCHCC Membership Payment Form
This form is designed to complete your membership application that we already have on file.

Required fields are marked with a red (*) asterisk
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  • FCHCC Membership Levels and Fees:

    Strategic Partner - $10,000
    Leadership Trustee - $5,000
    Large Corporation #2 (1,000+ employees) - $2,500
    Large Corporation #1 (100 - 1,000 employees) - $1,500
    Small Business #2 (50 - 100 employees) - $500
    Small Business #1 (49 or less employees) - $300
    Non-profit #3 Organization 501 (c)3 (76+ employees) - $800
    Non-profit #2 Organization 501 (c)3 (26 - 75 employees) - $400
    Non-profit #1 Organization 501 (c)3 (25 or less employees) - $200
    Individual Member (not representing a company) - $150
    Student Member - $25
  • Credit Card processing fees: Strategic Partner - $300; Leadership Trustee - $150; Large Corporation #2 - $75; Large Corporation #1 - $45; Small Business #2 - $15; Small Business #1 - $9.00; Non-profit #3 Organization - $24; Non-profit #2 Organization - $12; Non-profit #1 Organization - $6.00; Individual Member - $4.50; and Student Member - $.75
  • When paying by credit card, you will be redirected to our payment system after you submit this form.


    PLEASE NOTE: a credit card processing fee will be added at checkout.