Association Membership Application

Association Membership
Application
1. Corporate Information
Company Name __________________________________________________________________________
Address _________________________________________________________________________________
City __________________________________ Province __________ Postal Code ___________________
Telephone _____________________________________ Fax _____________________________________
Website __________________________________________________________________________________
Language of correspondence

 English

 French

2. Primary Contact
  Mr.

 Mrs.

 Ms.

 Dr.

Name ________________________________________ Title _____________________________________
Address _________________________________________________________________________________
City __________________________________ Province __________ Postal Code ___________________
Telephone ______________________________________ Fax ____________________________________
Email ____________________________________________________________________________________
Language of correspondence

 English

 French

3. Invoice Recipient
  Mr.

 Mrs.

 Ms.

 Dr.

Name __________________________________________ Title ____________________________________
Address _________________________________________________________________________________
City __________________________________ Province __________ Postal Code ___________________
Telephone ______________________________________ Fax ____________________________________
Email ____________________________________________________________________________________
Language of correspondence

 English

 French

4. Areas of Interest
Please rank your top three and mark other areas of interest with a check mark.
 Aboriginal Affairs and Canada’s North

 Intellectual Property

 Science and Technology

 Canada-U.S.

 Internal Trade

 Skills and Immigration

 Competition Policy

 International Affairs

 Small- and Medium-sized Business

 Environment

 Labour Relations

 Tourism

 Fiscal Policy

 Natural Resources and Energy

 Transportation

 Infrastructure

 Responsible Business Conduct

 Innovation

 Retirement Savings

 Other areas of policy interest: ________________________________________________________________

Top countries/regions your company does business in:
1. _____________________________ 2. ___________________________ 3. ____________________________

5. Officers of the Company
List the two highest-ranking company officials to be contacted.

Name _________________________________________ Title ____________________________________
Address _________________________________________________________________________________
City __________________________________ Province __________ Postal Code ___________________
Telephone ______________________________________ Fax ____________________________________
Email ____________________________________________________________________________________
Preference of correspondence

 English

 French

Name _________________________________________ Title ____________________________________
Address _________________________________________________________________________________
City __________________________________ Province __________ Postal Code ___________________
Telephone ______________________________________ Fax ____________________________________
Email ____________________________________________________________________________________
Preference of correspondence

 English

 French

6. Membership Investment
Annual Investment ______________+ applicable taxes (HST Registration # 106844285)= ____________ Total
  Invoice me

 Cheque attached

 Visa

 MasterCard

 Amex

Credit Card No. _____________________________________________________ Expiry Date ________
Name / Title ______________________________________________ Telephone ____________________
Cardholder’s Signature ____________________________________________________________________
Servicing Director, Corporate Relations ______________________________________________________

7. Type of Industry
 Accommodation

 High Technology

 Printing & Production

 Advertising, Marketing & Communications

 HR & Payroll Services

 Real Estate & Development

 Agriculture

 Importing & Exporting

 Retail Trade

 Arts, Entertainment & Recreation

 Legal Services

 Skilled Trades

 Construction & Engineering

 Logging & Forestry

 Transportation & Warehousing

 Finance & Insurance

 Manufacturing

 Utilities

 Food & Beverage Services

 Media

 Wholesale Trade

 Health Care & Social Services

 Mining, Oil & Gas

 Other Business Services

8. I would like more information on:
 Canadian Chamber of Commerce background information

 Policy committees

 Event sponsorship opportunities

 Products and services

 Carnet and Document Certification

 Advertising opportunities

 National Business Leaders Roundtables

 ICC publications

Any personal information provided on the attached form will be used by the Canadian Chamber of Commerce, as set out in
our Privacy Policy, to conduct the transaction indicated on this form. Please consult our Privacy Policy, available online at
Chamber.ca or contact our Privacy Officer at [email protected] or 613.238.4000 x 229.

Chamber.ca

Thank you for filling out this form. Please send it to the Chamber representative nearest you.

OTTAWA
420 - 360 Albert Street
Ottawa, ON K1R 7X7
613.238.4000
613.238.7643
[email protected]

TORONTO
901 - 55 University Avenue
Toronto, ON M5J 2H7
416.868.6415
416.868.0189
[email protected]

MONTREAL
709 - 1155 University Street
Montreal, QC H3B 3A7
514.866.4334
514.866.7296
[email protected]

CALGARY
PO Box 38057
Calgary, AB T3K 5G9
403.271.0595
403.226.6930
[email protected]

Association Fee Schedule
We are pleased to offer the following association membership options:

Option A: $500*
Includes access to information; engagement, at the discretion of the policy department, in policy development
and advocacy; and the opportunity to be listed on our website as a member in good standing.

Option B: $1,250*
In addition to Option A, includes eligibility to be represented on our policy committees, excluding the Ottawa
Liaison Committee.

Option C: $1,500*
In addition to Option B, includes access to all our cost-saving affinity programs.

Option D: $2,500*
In addition to Option C, includes eligibility to be represented by the CEO, Executive Director or President
on the Ottawa Liaison Committee as well as at the international policy level on any appropriate ICC and
BIAC/OECD committee.

Option E: $5,000*
In addition to Option D, includes the opportunity to collaborate with us on major policy messages
and access to selected events, including an exclusive semi-annual gathering of association CEOs and
members of our management team.
Note: Associations paying an annual fee of $1,250 or more will be eligible to reduce their fee by 10% if
they agree to send a letter, or other such message, to their members promoting the merits of corporate
membership with the Canadian Chamber of Commerce.

Annual Membership Fee
SUBTOTAL

__________________________________________________

*plus applicable taxes

__________________________________________________

equals TOTAL FEE

__________________________________________________

*The applicable tax rate will be based on the member’s province/territory of residence. AB, BC, MB, NT, NU, SK,
YT: 5% GST | QC: 5% GST + 8.5% QST | NB, NL, ON: 13% HST | PE: 14% HST | NS: 15% HST |
Outside of Canada: 15% HST