www.medicinehatchamber.com
(403) 527-5214 Fax: (403) 527-5182
[email protected] 413 6th Ave SE Medicine Hat AB T1A 2S7
MEMBERSHIP APPLICATION FORM COMPANY INFORMATION
(this information will be published on the Chamber website with your business consent, unless otherwise specied)
Company Name:__________________________________________ Primary Phone: Company Email: __________________________________ Website: Physical Address: __________________________________City: ___________________ Postal Code: Mailing Address
(if different from physical & will NOT be published on the website):
City: __________________________________________________ Full Time Employees:
Part Time Employees:
Postal Code: _________________
Business Start Date (if known):
YES. I hereby authorize the Chamber of Commerce to list on its website (apart from the mailing address), and refer to inquiring customers contact information including company name, address, phone and website.
BUSINESS REPRESENTATIVES
(this information will NOT be published on the Chamber website)
Primary Contact Person:
Primary Contact Phone:
Position: ________________________________ Primary Contact Email: Additional Rep: _____________________________ Position: ___________________ Email: Additional Rep: _____________________________ Position: ___________________ Email: Additional Rep: _____________________________ Position: ___________________ Email: YES. I understand that all Chamber correspondence is sent by email and consent to having my electronic messages sent to the email addresses listed above. If I choose to opt our, I understand that the information I receive from the Chamber will be limited.
SHOP LOCAL PROGRAM
(only need to complete if offering a discount)
Would you be interested in additional exposure by offering a Shop Local incentive to fellow Chamber members? If yes, please ll out the following agreement: I agree to offer (be specic as possible) For the period of September 1, 20
to August 31, 20
OR from
Authorized by (signature):
WHAT PROGRAMS AND SERVICES WOULD YOU LIKE ADDITIONAL INFORMATION ON Community Support & Advocacy Advertising discounts Member Information Centre (MIC) Highway cluster signs Digital Marketing packages Free boardroom space Group Insurance Trade Show Networking
Self-Employment Training discounts Sponsorship opportunities Purchasing Connections bulletin Home & Auto Insurance Bank Merchant services Payroll & HR solutions Financial Health check Shipping discounts Fuel discounts
to
Y
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NEW MEMBERSHIP INVESTMENT OPPORTUNITIES st
st
Fiscal year runs September 1 - August 31
STARTER
Offer is only valid for the rst 2 years of business
$200
STABILIZER
$250
CONNECTOR
$400
INFLUENCER
$500
PROMOTER
$750
COMMUNITY BUILDER
$950
Associate Membership: 50% discount for qualied members who meet one or more of the following criterial: 1) Secondary Branch - An organization that has multiple branches whereby one branch pays full membership and secondary branches as an associate 2) Subsequent business - For owners with multiple business whereby one business already pays full membership (owner must have at least 50% ownership in both) 3) Large Corporations - Professionals who are part of a large private or public corporation that has already taken out a Chamber member (ie. Realtors) 4) Leasee - For business who lease property space in a 50+ multi-business retail facility whose property owner is the primary lessor who pays full membership ∙All primary members must have paid in full prior to the associate member being granted the 50% discount (ie. If the primary member is a new member, they must pay the full membership dues on or before September 1st of each year. Associate membership discounts will not be applied retroactively.
PAYMENT DETAILS
Membership Investment Type STARTER
STABILIZER
CONNECTOR
(please circle one)
INFLUENCER
PROMOTER
COMMUNITY BUILDER
Application Date: Annual Investment: Prorated GST
(until August 31):
(#R1076876991):
TOTAL: Credit Card #:________________________Exp: __ /__ CVV:
CODE OF CONDUCT By signed this document and renewing our membership with the Medicine Hat & District Chamber of Commerce, we: 1. Pledge to conduct business in a professional and reputable manner, including complying with application legislation, providing clear and accurate contracts and communication regarding our products and services, and offering to settle any customer complaints in a timely and effective manner; 2. Strive to communicate, co-operate and collaborate in the promotion, development and enhancement of business growth and activities within Medicine Hat and our surrounding area; 3. Respect the good reputation, prole and status of the Chamber and represent the Chamber accordingly.
_______________________________________________ Signature
_____________________________________ Date
