Chamber Membership Registration Form

Chamber Membership Registration Form If you prefer to print the application form, view a printable PDF version here. Bold fields are required
Name of Business:
Contact Person:
Phone:
Toll-Free Phone:
Mobile Phone:
Fax:
Storefront Address
Street:
City:
Postal Code:
Mailing Address (if different)
Street:
City:
Postal Code:
Email Address:
Show email address on website:
Website Address:
Category:	Choose an existing category from the list: Or enter a new category:
Description:
Can you volunteer to sit on a Chamber Committee?
If so, which area interests you?
Do you require a receipt?
Are you attending the Annual General Meeting on January 24, 2012?
If so, how many people will be attending?
Please enter the confirmation code 4966 in the box:

Please make your cheque payable to "Newcastle and District Chamber of Commerce" and mail to:20 King Ave. W., Box 11Newcastle, Ontario L1B 1H7.