Membership Application

* Denotes a required field
Membership Information
*Business Name
*Address

*City
*Province
*Postal Code
*Telephone
Tollfree
Fax
*Email
Website
Business Category
Contact Person for Organization
*First Name	*Last Name
Email
Other Contacts
Name:	Email
Name:	Email
Name:	Email
*# of Full Time Employees
Referral
Membership Information
*Username
*Password
*Confirm Password

Membership Type
Business		(Rated Per Employee)
Charity Registered Charity Number Required:		(Rated Per Employee)
Multi-Branch Members with a Main Branch operating other branches		$143.41
Corporate Members owning multiple businesses		$89.63
Individual Retired Chamber Members, Students, Teachers and Clergy		$0.00
Outside Members outside the Greater Fredericton Area		$165.81
		Tax (HST):
		Total: