I/We hereby apply to the Chatham-Kent Chamber of Commerce and I/We agree my annual investment in membership shall be $ payable annually in advance. The Chamber of Commerce reserves the right to amend the annual membership fee as deemed appropriate.
Name of Firm:
Name of Representative:
Position Held:
Business Address: Postal Code:
Business Phone: Business Fax:
E-Mail Address: Web Site:
No. of Employees: F/T: P/T:
Business Classification:
Interested in Group Insurance Program? YES NO
 
I/We agree not to use Chamber Membership in promotion and advertising without prior written consent of the Chatham-Kent Chamber of Commerce.