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Administration Information

Business Name(Required)

Contact Name(Required)

First Last

Business Address

Street Address Address Line 2 City Province Postal Code

Business Phone(Required)

Mobile Phone (Optional)

Invoicing Email Address(Required)

The invoice will be issued to the email address above unless an alternate is noted here.

Communications Contact (who will distribute information to your staff)

Communications Contact's Email Address

Directory Information

Business Category (Please Select)(Required)

Additional Category

Business Description for Print and Online Directories(Required)

Additional Comments - Enhanced members allowed 400 characters in directory.

Phone number for directory listing:

Email for directory listing:

Website for directory listing:

Facebook Address:

Twitter Address:

Instagram Address:

LinkedIn Address:

Membership Information

Membership Type

Basic $220 + HST

Enhanced $600 + HST

Total

Credit Card

Card Details

Cardholder Name

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