Member - #MICRONET_HEADING# – Lloydminster Chamber of Commerce

Thank You for applying online for Chamber Membership. Chamber Memberships run from January to December. New Memberships are prorated depending on month joined. New Members who join in November or December receive those months for free and are charged for a full price Membership for the next calendar year. Memberships are subject to GST. PLEASE NOTE: Part-time employees count as 1/2 employee. For example, if you have 3 full-time and 4 part-time employees = 5 employees. 2 full-time and 1 part-time = 3 employees. Corporate Memberships are also available. Please contact the office to inquire.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Products/Services:

Why Joined:

Group Insurance:

Sponsorship Interest:

Advocacy Concerns:

Newsletter: *

Physical Address

Line 1: *

Line 2:

City: *

Province: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

Province: *

Postal Code: *

Country: *

Social Networking:

LinkedIn Facebook Twitter

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1: *

Line 2

City: *

Province: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn Facebook Twitter

Address

Same as Member Address

Line 1: *

Line 2

City: *

Province: *

Postal Code: *

Country: *

Print Application

Member Application

Mailing Address

Address

Address