Medicine Hat & District Chamber of Commerce

Please complete the following form, using your "tab" key or your mouse key to move the cursor to the next section. Do not press enter until the form is completed. Once completed, press enter or click on the "submit" on the bottom of the form to send your application to our office.

If you prefer you can print the form and send it in to us at (403) 527-5182
or mail it to
413 6 Avenue SE
Medicine Hat, AB T1A 2S7

MEMBERSHIP FORM

Company Name:

Mailing Address & Postal Code:

Physical Address if different from mailing:

Phone #: Fax #:

Web site: Company Email:

Number of full time employees:

Number of part time employees:

Anniversary date of your business:

Main contact person & title:

Contact Person Email:

Names & titles of other contacts if applicable:

Preferred method of receiving Chamber information:

Is this a home based or mobile business? Yes No

Would you like to receive MERX bulletins (MERX is Canada's official public-sector tendering service)? Yes No

Would you like to volunteer for the Chamber of Commerce on committees or for events? Yes No

Would you be willing to participate in surveys? Yes No

What Specific Services are you looking for?

Advocacy
Events/Networking Opportunities
Chamber Newsletter
Boardroom Usage
Membership List
Grand Opening & Special Event Assistance
Referral Program
Business Magazine
Trade Show Discounts
On-Line Business Directory
Radio Advertising
Highway Cluster Signs
Medicine Hat News Advertising
Member2Member Discounts
Tricube Web Discount
Explore Visitor Information & Relocation Guide
Sponsorship Opportunities
Merchant Discount Rates
Fuel Discounts
Group Insurance Benefits
Payworks On-Line Payroll Services
CEG Natural Gas Supply Program
Adtel On-Hold Infopacs
Chamber Seal
Purolator Courier Discounts

As a member of the Medicine Hat & District Chamber of Commerce, your organization has the opportunity to have its contact information listed on our website, free of charge. As well, your business can be referred to potential clients or customers. However, in compliance with PIPEDA information must be gathered with consent, collected for a reasonable purpose, used for the limited purposes for which it was gathered, accurate, open for the owner's inspection and correction, and stored securely.

YES, I hereby authorize the Chamber of Commerce to list on its website & refer to inquiring clients/customers, contact information including company name, address, phone, fax, e-mail or website.

NO, I DO NOT authorize the Chamber of Commerce to list on its website & refer to inquiring clients/customers, contact information including company name, address, phone, fax, e-mail or website.

Fees are to be pro-rated to August 31st of the year.

Annual Investment:

Individual:	$157.50 + gst
1 - 6 Full-Time Employees:	$199.50 + gst
7 - 15 Full-Time Employees:	$233.10 + gst
16 - 50 Full-Time Employees:	$333.90 + gst
51+ Full-Time Employees	$598.50 + gst
Family Farm:	$199.50 + gst
Non-Profit, Retired & Student:	50% of actual cost

The Chamber of Commerce excepts VISA, MasterCard, American Express, Debit Card, Cash or Cheque.

Amount paid including GST: $

Method of Payment (choose one)

Credit Card: Number Expiry:

Cheque to be mailed

Other please describe

As one of the perks of being a new member of the Chamber you receive a free 100 word business profile, describing your business and the goods and/or services you provide. This profile will then appear in the Chamber Chatter Newsletter and Chamber Business Magazine. We will include your company name, address, phone number as well as fax, email and website, if applicable. Please provide us with your 100 word business profile for our "New Members" section of the Newsletter and magazine.

Thank you for taking the time to fill out this application form. Upon receipt of the application and payment, you will immediately become a member of this great organization. Should you have any questions about your membership, please feel free to contact our office at any time.