Join

APPLICATION

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Registration form

Burrum Chamber of Commerce membership

Information required of applicant as per below

1…Full name and address of business owners

Name

Address

……………………………………………………………………………………………….

2…Contact phone numbers including mobile and fax

PH.………………….. FAX……………………. M………………………………………..

3…Email address and any web site addresses

Email

Web

……………………………………………………………………………………………….

4…ABN # or Business registration # Business name, location, PO Box

ABN#………………….. BRN#……………. PO Box ……….@……………..PC……..

Location

……………………………………………………………………………………………….

5…Photos – up to five. Personal photos + of business activities/products

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CURRENT MEMBERSHIP FEE FOR THE YEAR IS $40

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MEMBERSHIP

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*Registration entitles member to a profile page on the web site   complete with photo and business details

Signed by applicant

…………………………………………………………………Date……./……./……….

Regards

Henry Sapiecha s-logo-hs-signature2

Publicity Officer

Burrum Chamber of Commerce

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