Pender Island Chamber of Commerce - 2010 Member Application Form

Business Name:

Please enter a business name.

Contact Person: Title (optional), First and Last Name

Dr. Miss Mr. Mrs. Ms. Prof. Please enter a first and last name.

Business Title:

Assistant CEO Contact Controller Director Legal Assistant Manager Owner Owner / Operator President Realtor Realtor Sales Representative Secretary Treasurer Vice-President

PO Box (# only)

Street Address:

Please enter a street address.

City:

Pender Island Salt Spring Island Victoria Vancouver Sidney Saanichton Brentwood Bay Richmond North Vancouver Port Coquitlam Maple Ridge Langley Kelowna Calgary Sherwood Park Kirkland Mayne Island North Saanich Kenmore Saturna Surrey Las Vegas South Pender Island Nanaimo Delta Duncan

Province / State:

British Columbia Alberta Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Postal / Zip Code

Please enter a postal code.

Mailing Address:

Mailing Address City:

Pender Island Salt Spring Island Victoria Vancouver Sidney Saanichton Brentwood Bay Richmond North Vancouver Port Coquitlam Maple Ridge Langley Kelowna Calgary Sherwood Park Kirkland Mayne Island North Saanich Kenmore Saturna Surrey Las Vegas South Pender Island Nanaimo Delta Duncan

Mailing Address Province / State:

British Columbia Alberta Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Mailing Postal / Zip Code

Local Phone Number:

Please enter a phone number. Please enter a valid phone number.

Toll Free Phone Number:

Fax Number:

Cell Phone Number:

Business Email Adress:

Please enter an email address. Please enter a valid email address.

E-mail if different from business

Web Site URL:

(please select up to three applicable categories.)

Bed and BreakfastsResorts, Lodges and InnsVacation RentalsArts, Crafts and GalleriesFarms, Vineyards and WineriesHealthMarinasReal EstateRecreation and CulturalRestaurants and PubsRetailServicesTradesTransportation

Do you wish to be listed on the Chamber web site?

Yes

No

If yes, please provide a brief description of your business:

(35 words maximum)

Do you want to be listed in the Chamber brochure?

Yes

No

Would you like a business locator on the map (cost of $40.00)?

Yes

No

Two of the following fields will be listed on the brochure in addition to your business name. Please indicate your preference in order of priority.

• Local Phone Number
• Toll Free Number
• Business Website URL
• Business Email Address

Other info.

(e.g. hours of operation, location)

Do you wish to advertise at the Chamber Info Centre?

Yes

No

If yes, please indicate which of the following you will be providing:

Business Cards

Brochures

Cards & Brochures

Click here for a Printable Application Form

Drop off membership form and payment in the Chamber folder at Pender Island Realty office or mail to:

Pender Island, BC
V0N 2M0

Please make cheques payable to Pender Island Chamber of Commerce.

Service Fees