Member Application

Thank you for your interest in membership with the Cold Lake Regional Chamber of Commerce. Membership fees are based on the calendar year (January 01 - December 31)

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max): *

Directory Category:

Employees:

Full-time Part-time

Business Keywords (enter a space between words): *

Comments / Questions:

Year Business Started: *

Were you referred by a current member? If yes, provide business name.:

Physical Address

Line 1: *

Line 2:

City: *

Province: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

Province:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

Province: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Login: *

Password: *

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

Province: *

Postal Code: *

Country: *

Print Application

Our Corporate Members

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Cold Lake Regional Chamber of Commerce

Phone: (780) 594-4747
Toll Free: 1-800-840-6140
Fax: (780) 594-3711

PO Box 454
4009 50th St
Cold Lake, AB T9M 1P1

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