Membership Application and Renewal Form

Business Name:

Address:

Address Line 2:

City:

Postal Code:

Phone:

Fax:

Website:

First Name:

Last Name:

Email Address:(required)

Type of Business and Products / Services provided:

Business Description:

Number of Owners:

Number of Employees - Part-Time:

Number of Employees - Full-Time:

How did you hear about the Perth and District Chamber of Commerce?
Member ReferralNew BusinessWord of MouthAdvertisementOther

What are the top 3 benefits of being a chamber member that you consider to be most value to you / your business?
Networking Programs/FunctionsGroup Insurance/BenefitsMember ReferralsPresence on Chamber WebsiteM2M Value Program

The above information will be used to promote your business through personal referrals and on the Chamber of Commerce website. As well, the information will be forwarded to TD Canada and Doucett Insurance in order to provide you with information on better bank and insurance rates through the Canadian Chamber of Commerce. A representative from TD Canada will be contacting you. The Chamber will not use personal information for any purpose other than that for which you have consented. It shall be kept confidential and for the exclusive use of the Perth and District Chamber of Commerce and the above mentioned authorities.

Please check if you agree with the above statement.Please check if you do not want any information forwarded to TD Canada or Doucett Insurance.

Check below if you would like to receive the following:

2017 Chamber of Commerce member decal2017 Ontario Chamber of Commerce member decal

Check here to receive information from the Chamber of Commerce office or from the Chamber's website including, but not limited to: emails, newsletters, promotions, press releases, referrals and information that the Chamber feels relevant.