New Member Application Business name(Required)Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone(Required)Email(Required) Website Owner Name (Key Contact)(Required) First Last Owner Email Key contact(Required) First Last Key contact phone(Required)Key contact email(Required) Accounts Payable First Last Business Classification Sole Proprietor Corporation Ltd. Non Profit DescriptionPlease provide a description of your business, products and/or services (40-50 words):Membership Fee: Please invoice Pay online Annual fees: $200.00 - Standard $100.00 - Non-ProfitAre you interested in joining any of the Chamber of Commerce Committees or Board of Directors? Events Committee Business Advocacy Committee Chamber Board of Directors What Services Are You Looking For? Chamber Group Insurance Plan Member Discounts (Affinity programs, POS) Networking opportunities Business Referrals Exposure / Networking Consent for Communications Yes, I consent to receive the Chamber newsletter by email Yes, I consent to receive all other types of email communications from the Chamber (event notifications, surveys, etc.) Yes, I would like to receive invoices and statements by email. Information Authorization Release(Required) Yes, I hereby authorize the Springfield Chamber of Commerce to list the following information on it’s website, and refer to inquiring customers: Company name, address, contact information (phone, email, website). No, I do not authorize the Chamber of Commerce to list my information on its website or refer it to inquiring customers. As a member of the Springfield Chamber of Commerce, your business or organization has the opportunity to have its contact information listed on the Chamber website. In accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Personal Information Protection Act (PIPA), any organization or business must authorize the release of such information. Also, the information must be gathered with consent, be collected for a reasonable purpose, used for the limited purposes for which it was gathered, be open for the owner’s inspection and correction, and be stored securely. Authorized by:(Required) First Last Authorized contact email(Required) Form security question - 2 + 2 =(Required)CAPTCHA