BECOME A CHAMBER MEMBER TODAY! 2016/17 Membership Application Form Download this as a PDF Business Name:*Business Owner*Business Anniversary:Contact Name:*Phone*Fax Number:Email* Website Mailing Address:*Physical Address:*Membership Fee StructureMembership:*Please check Membership level with The Chamber of CommerceGold Membership - $1500.00 + GST = $1575.00Silver Membership - $1000.00 + GST = $1050.00Bronze Membership - $500.00 + GST = $525.001-2 Employees - $225.00 + GST = $236.253-5 Employees - $259.50 + GST = $272.486-19 Employees - $300.00 + GST = $315.0020+ Employees - $350.00 + GST = $367.50Charitable Organization - $125.00 + GST = $131.25Home Based Business - $200.00 + GST = $210.00Paymeny by:**GST# 107569279VisaMastercardOther Credit CardDebit CardChequePIPEDA - Personal Information Protection and Electronic Documents ActPlease fill out the PIPEDA portion if you would like to be listed on the website directory, newsletter or reader board. If you do not fill out the PIPEDA portion we cannot promote your company where availableList your business:*I acceptI declineI give the Kindersley Chamber of Commerce permission to refer to, and to list my business information as I have provided.Full Name:*Date Please fill out the following information.Newsletter:*If you're interested in hearing from use sign up for our newsletter! Email Fax Chamber Plans:Would you want more information on Chamber Plan Benefits?YesNoVolunteer:I would like to lend a hand. Board of Directors (Second Tuesday of every month) Welcome Night (October) Trade show (June) Goose Festival (September) Winter Wonderland (November-December) Business DescriptionPlease provide a short description (50 words or less) of your business to help us promote your business. We reserve the right to modify your description to fit editorial constraints ( PIPEDA must be signed in order for us to use this information).Provide up to three keywords to describe your business (used on the website directory, PIPEDA must be filled out):1)2)3)Suggestions:Please Share any ideas or suggestions you have for the upcoming year:Thank you, we value your ideas and comments. We will take them into consideration. We are glad to have you as part of our membership.You chamber membership is 100% tax deductible as an operating expense. Membership renewals are due by January 31st of the current membership year.