2016-AACC Membership Application

Please Provide the Following Information Completing all Fields Requested
Business Name
Contact Name
Business Address
Phone Number(s)
Email Address
Website Address
Signature
Date
Are you a current Angus & Area Chamber of Commerce Member?
Yes
No
Contact Name
Angus & Area Chamber of Commerce Membership Application
Member Dues Paid (see below for fee)
I agree to be bound by the Angus & Area Chamber of Commerce By-laws
Yes
No
Signature
Date
Month Joining Rate Months Paid For HST TOTAL
September 135.00 12 17.55 152.55
October 123.75 11 16.09 139.84
November 112.50 10 14.63 127.13
December 101.25 9 13.16 114.41
January 90.00 8 11.70 101.70
February 78.75 7 10.24 88.99
March 67.50 6 8.78 76.28
April 56.25 5 7.31 63.56
May 45.00 4 5.85 50.85
June 33.75 3 4.39 38.14
July 22.50 2 2.93 25.43
August 11.25 1 1.46 12.71
Name of Sales Representative
Size of Ad Purchased
To Be Completed By Sales Representative
Advertising and/or Membership Dues Paid?
Yes
No
Amount Paid
Paid By
Cash Cheque PayPal