CLEARWATER & DISTRICT CHAMBER OF COMMERCE

425 E. Yellowhead Highway

Box 1988 RR#1 Clearwater, BC V0E 1N0

Ph: (250) 674-2646 Fax: (250) 674-3693

Website: www.clearwaterbcchamber.com Email: info@clearwaterbcchamber.com

2008 MEMBERSHIP APPLICATION FORM

Your Chamber Business Membership Fee includes a listing on our website at www.clearwaterbcchamber.com  please ensure that you have

provided us with accurate information.

Business Name:                                                                                                                                                                                                          

Also Known as (this will appear on our Membership List and Website):                                                                                                                                                                                                                                         

Phone#:                                                                                   1-800#:                                                                     Fax:                                             

Mailing Address:                                                                                                                                 Postal Code                                                  

Physical Address (if different from above):                                                                                                                                                             

E-Mail:                                                                                                   Website:                                                                                                         

Voting Representatives for my business shall be:

Name:                                                                                                                     Contact Phone:                                                             

Name:                                                                                                                     Contact Phone:                                                             

Description of Business for chamber website:                                                                                                                                                         

We/I hereby authorize the Clearwater & District Chamber of Commerce to include my business name and contact information on the

Chamber website:

Authorized Signature                                                                                              Date

PLEASE NOTE: For every member, we submit an assessment of $11.00 to the BC Chamber of Commerce and the Canadian Chamber of

Commerce, this fee is included in your membership costs.

I hereby apply for membership under category#                                            Number of full time employees:                        

Signature:                                                                                                                              Date:                                                                    

Category                                                Annual Fee           GST                        TOTAL                 # Votes

Business:                                                                                                                                                             

                                                                                                                                                                                                Date:                                      

1. 1-3           Employees             $ 90.00                    $4.50                       $94.50                          1
2. 4-10         Employees             $130.00                   $6.50                       $136.50                        2                         Annual:                 
3. 11-60       Employees             $170.00                   $8.50                       $178.50                        3
4. 61+          Employees             $210.00                   $10.50                     $220.50                        4                         GST:                                      
5. Racking Fee                          $80.00                     $4.00                       $84.00

Associate:                                                                                                                                                                             Total Paid:                            

6. Individual                              $30.00                     $1.50                       $31.50                          1
7. Organization                         $55.00                     $2.75                       $57.75                          1                         Cash/Cheque:                      

For the purpose of computing fees, the term “number of employees” shall
represent the average number of full time employees, including owners