California Employer Advisory Council

Santa Clara County EAC Membership Form

August 25, 2010

Today's Date
September 10, 2010
Membership Type
New  Renewal 
Company Name:

Name of Member:

Job Title:

Address:

City:

Zip:

Phone:

Fax:

Email:

Type of Business:

Number of Employees:

Years in Business:

Type of Entity:
Profit  Nonprofit  Government Agency 
Would you be willing to serve on a committee?
Yes  No 
How did you hear about the EAC?


To prevent SPAM please enter the word you see in the image below:

Membership dues: $60.00 per company for one year. After submission you will have the option to pay online.

Note: The information given is strictly confidential, for the exclusive use of the Employer Advisory Council, and the California Employer Advisory Council. This information may not be used for solicitation, the creation of mailing lists, or any other unauthorized use, and will not be released unless authorized by statue.