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Application

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Organization Information (to be displayed online)

Organization Name

Address 1

Address 2

City

Province

Postal Code

Phone

Fax

Website

Business Profile

Business Start Date (month/day/year)

Please list your social media sites:

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TripAdvisor

Main Contact

First Name

Last Name

Title

Phone

Additional Contacts

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Contact 1

First Name

Last Name

Title

Email Address

Contact 2

First Name

Last Name

Title

Email Address

Contact 3

First Name

Last Name

Title

Email Address

Contact 4

First Name

Last Name

Title

Email Address

Contact 5

First Name

Last Name

Title

Email Address

Contact 6

First Name

Last Name

Title

Email Address

Contact 7

First Name

Last Name

Title

Email Address

Contact 8

First Name

Last Name

Title

Email Address

Contact 9

First Name

Last Name

Title

Email Address

Contact 10

First Name

Last Name

Title

Email Address

Billing/Mailing Address (if different)

Address 1

Address 2

City

Province

Postal Code

Additional Information

What is your reason for joining?

How did you hear about us?

Website
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Postcard from Chamber
Member Referral
Other

Are you interested in offering a Member to Member discount? YesNoI would like more information

Membership Investment

Primary Directory Category

Number of Full Time Employees

Number of Part Time Employees

Annual Membership Investment

One-Time Application Fee

Tax

Total

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Additional Items

Additional Categories Cost

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

Millions in Assets

Enhanced Membership ($50)

Additional Directory Categories

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Membership Type

Full-Time Employees

Part-Time Employees

Hotel/Motel Rooms

Restaurant Seats

Additional Associates

Additional Associates Cost

Additional Locations

Additional Locations Cost

Assets

Assets Cost

Additional Categories

Number Of Additional Categories

Additional Categories Cost

Additional Item 1 Cost

Additional Item 2 Cost

Additional Item 3 Cost

Additional Item 4 Cost

Additional Item 5 Cost

Additional Item 6 Cost

Additional Item 7 Cost

Additional Item 8 Cost

Additional Item 9 Cost

Additional Item 10 Cost

Annual Dues (charged to card)

Revenue Item

Tax (charged to card)

Fee (charged to card)

Temp Value For DropDown 1

MembershipType

Additional Item 2

Additional Item 3

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Additional Item 5

Additional Item 6

Additional Item 7

Additional Item 8

Additional Item 9

Additional Item 10

Payment Type

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Credit Card Information

Credit Card Type MastercardVisa

Credit Card Number

Name on Card
Security Code
Valid Through
Address
City
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Postal Code
Phone
Credit Card Email Address

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The Chamber
705.360.1900
76 McIntyre Rd
Schumacher, ON P0N 1G0

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