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Shoalhaven Business Chamber Membership Application

Business Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Contact Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Business Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postal Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone Number . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobile . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fax Number . . . . . . . . . . . . . . . . . . . . . . . . . . .

Note: Correspondence is sent by email unless specified otherwise.

 

Membership: twelve months

Membership is for the business and covers only one representative to vote on any issue. Additional representatives and guests are welcome to any meeting.

___ 1-10 Employees      ___ 11-40 Employees        ___40+ Employees

$180.00 incl. GST          $260.00 incl.GST              $330.00 incl. GST

 

Why do you wish to join the Chamber?

__ Networking    __Advocacy    __Social    __Educational/Professional Development

__Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

Core Business

Please tick which best describes your business and then specify eg. Retail, Florist

__ Retail . . . . . . . . . . . . . . . . . . . . . . . . .      __ Employment & Training . . . . . . . . . . . . . . . . . . . . . .

__ Professional . . . . . . . . . . . . . . . . . . . .      __ Industry/Manufacturing . . . . . . . . . . . . . . . . . . . . . . .

__ Sales . . . . . . . . . . . . . . . . . . . . . . . . .      __ Financial Institution/ Advisor . . . . . . . . . . . . . . . . . . . 

__Trade . . . . . . . . . . . . . . . . . . . . . . . . . .     __ Building/Construction . . . . . . . . . . . . . . . . . . . . . . . .

__Other . . . . . . . . . . . . . . . . . . . . . . . . . .     __Hospitality/Tourism . . . . . . . . . . . . . . . . . . . . . . . . . .

 

Privacy

Do you object to your business name and contact details being included in a member's directory?

__No      __ Yes

 

Payment

   __Invoice required    __Cheque enclosed    __Bank deposit

__ Credit Card Number: ______ ______ ______ ______ Exp ____ / ____ $__________

 

Please return completed application form to: Shoalhaven Business Chamber PO Box 361, Nowra 2541