Membership Application Form

Name of Company:
Physical Address:
Mailing Address:
City:
Postal Code:
Telephone:
Fax:
Website:
Email:
Name of Owner:
Contact Name:
Position:
What is your reason for joining the Elliot Lake & District Chamber of Commerce?
Form of Business:
Number of Employees:
Company Start Date or Number of Years in Business:
Description (List products and services provided):
Have you ever been a member of the Chamber?
Yes
No

(if yes, when?)
Do you belong to any other associations pertaining to your business?
Yes
No

(if yes, please provide the names of the associations)
Would you like more information on the Chamber's Group Insurance Plan?
Yes
No
Would you like to offer a member to member discount?
Yes
No

(if yes, please provide details)
Would you be interested in advertising in Business Matters?
Yes
No
Would you or one of your representatives be interested in participating on a Chamber Committee?
Yes
No

Only enter the 3 black characters:

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Elliot Lake & District Chamber of Commerce
Hwy. 108
Elliot Lake, ON
P5A 2T1

Seidel's Furniture... and more!
ELNOS Corporation for Business