Application

        2011 Membership Application           

                     Kindersley Chamber of Commerce

                                       Box 1537,  605 Main St., Kindersley, SK, SOL 1S0

                                              Ph: (306) 463-2320;   Fax: (306) 463-2312

                    Email:  kindersleychamber@sasktel.net; Website: www.kindersleychamber.com

         Business Name:            ____________________________________

         Contact Person(s):                                                                               

         Mailing Address: Box_____________St._______________________

         Phone:                                                                Fax:                             _

         Email Address:                                                                                      _

        Website:                                                                                                 _

        Business Anniversary:                           _________________________

        *{Please fill your Anniversary in if you wish to have it on the reader board, as well as a

            Christmas greeting.}

      2011 Fee Structure: (GST #: R1075692769) {**AFTER MARCH 31-THE FEE STRUCTURE}

 A.   1-5   Employees             $200.00 (+ GST)=  $210.00  A.   1-5  Employees       $225.00 (+GST)=  $236.25

 B.   6-19 Employees             $225.00 (+ GST)=  $236.25  B.   6-19 Employees     $250.00 (+GST)=  $262.50

 C.   20+  Employees             $250.00 (+ GST)= $262.50   C.   20+  Employees      $275.00 (+GST)=  $288.75

 D. Home Based Business   $175.00 (+ GST)= $183.75   D.   Home Based           $200.00 (+GST)=  $210.00

  Upon receipt of payment, your business information will be entered on the website 

  www.kindersleychamber.com (providing you have filled out the PIPEDA portion at the bottom of this

  page), as well as a welcome note on the reader board

ü           The Chamber offers group insurance for your business & employees (firms of 1 – 50 people), for more

m        information or to receive a free quote, please call  the insurance rep; Elan Kidd @ 1-866-794-7700 or email

h         her at @ elankidd@pccu.ca

_________________________________________________________________

*PIPEDA Information*                            

                                 PLEASE be sure to fill this out, ESPECIALLY NEW

                     MEMBERS.                      

  I,                                              give the Kindersley Chamber of Commerce

  permission to refer to, & list my business information as I have entered it above.

  Signature:                                               Date__________________                  

                                        Kindersley Chamber of Commerce’s

                                                 Major Events for 2011

February:        Annual Meeting            September:    Goose Festival

May:               Luncheon/Speaker        October:        Luncheon/Speaker

                                                                                   WelcomeNight                                                                                      

June:               Trade Show                 December:     Winter Wonderland

I am interested in volunteering in one or more of the following:

(Only check mark if you wish to be involved in any of the following.)

A.     Sponsors for Welcome Night:        ______

            B.  2011 Board of Directors:                           

C.  2011 Trade Show Committee:                   

D.  2011 Goose Festival Committee:                

E.  Other:                                                         

F.  Winter Wonderland                         ______

G.  None of the Above:                        ______         

I would like to receive the newsletter; as well as any other

            Chamber info via: (Please check one)

            EMAIL:                                               FAX:                            NO:________

Please share your new & exciting ideas for 2011:

Thank you for your continued support!

Please Note: This application is for one years’ membership with the Kindersley

Chamber of Commerce (January 2011 – December 2011)

Office Use Only:

Date/Received:                                                 Cheque#      ____________  

Date entered on Reader Board:                                                             _____

Date entered on website: