Test h217

Member's Name*
First Last
Member's Partner Name
First Last
Member's Business Name*
Only one business per membership
Business Phone Number*
Member's Mobile Phone*
Member's Home Phone
If applicable
Website
Description of Business
(maximum 50 words)
Do you want your business listed in our online business directory of Chamber members?*
Do you want your business featured in the Chamber's social media pages?*
Please enter your Facebook page address
Member's Email Address*
(this email along with your password will be used to log in to our online system)
Enter Email Confirm Email
Business Address*
Street Address Address Line 2 Suburb State Post Code
Password*
Enter Password Confirm Password
Type of Membership*
Membership is based on a full year commencing 1 August - 31 July each year.
Recurring Date
Date Format: DD slash MM slash YYYY

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