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 Canadas 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 ____________________
Cardholders 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 privacy@chamber.ca 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
info@chamber.ca

TORONTO
901 - 55 University Avenue
Toronto, ON M5J 2H7
416.868.6415
416.868.0189
info@chamber.ca

MONTREAL
709 - 1155 University Street
Montreal, QC H3B 3A7
514.866.4334
514.866.7296
info@chamber.ca

CALGARY
PO Box 38057
Calgary, AB T3K 5G9
403.271.0595
403.226.6930
info@chamber.ca

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 members 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