Maitland Business Chamber - Online Membership Registration

Company Details
Company or Organisation Name
Contact Person 1*
Title
Contact Person 2
Title
* Contact Person 1 should be the representative authorised to vote on behalf of the company/organisation

Contact Details
Street Address
Town/City
Post Code
Postal Address
Town/City
Post Code
Phone
Fax
Mobile
Email Address
Web Site

Company/Organisation Information
Type of Business (for classification purposes)
Number of personnel including Executives, Directors & Partners

Membership Subscription Rates (12 months)
Small 1-4 employees - $150
Medium 5-14 employees - $250
Large 15+ employees - $350

Privacy
From time to time the Maitland Business Chamber conducts/takes part in business surveys, educational programs, the distribution of newsletters and e-letters, the compilation of business directories etc. Our membership list is also available to financial members of the Chamber - another benefit of membership of the Maitland Business Chamber. Under the Privacy (Amendment) Act 2001, we are required to seek permission from our Members to use their business details in the above mentioned, and similar Chamber activities. Please indicate whether or not you are willing for your business details to be used for Maitland Business Chamber activities.
	Yes, I am willing for my business details to be used by the Maitland Business Chamber
	No, I am not willing for my business details to be disclosed to anyone outside the Maitland Business Chamber Executive.

Signed
Date

An invoice will be mailed on lodgement of this application.