Membership Application Form - membership application by hjkuiw354


									I am interested in receiving information on:

Chamber Connect Card               Company Directory

Chamber Networking                 Hospitality Events

Export Documentation               International Trade                 The Stable Block, Brewery Drive, Huddersfield, HD4 6EN
                                                                       T: 01484 483660

First Aid Training                 Health and Safety Training

Health Care                        Private Medical Insurance

Childcare Vouchers                 Policy and Representation

Sponsorship                        Marketing

E-Newsletter                       Close Up Magazine

                                                                Application Form

Office use only

Membership officer:              Memo of articles:

Membership no:                   Data capture form:

Welcome/Cert:                    Paid:

Date received:                   Added to CRM:
Company Name:                                                                  Membership Plans:
Contact Name:                                                                                            Sole Trader                 Professional           Premium Plan
                                                                                                       (1-3 employees)                   Plan
Job Title:                                                                            Month                £12.99 + VAT              £19.99+ VAT                £24.99+ VAT
Address:                                                                               Year               £155.88 + VAT              £239.88+ VAT               £299.88+ VAT

                                                                               Methods of Payment:                        Please Select Payment Method:
                                                                               1. Cheque                                 I enclose a cheque for: (please select)
                                                                               (Made payable to Mid Yorkshire            £183.16     £281.86     £352.36
Postcode:                               Telephone:                             Chamber of Commerce)

Company Email:                                                                 2. Direct Debit                           I enclose a completed and signed
                                                                               (See Direct Debit form, payment will    Direct Debit form.
                                                                                be collected on the 1st of each month)
Company Website:
                                                                               3. Credit Card                            Please charge to the credit card details
No. of Employees:                       Company Start Date:                    (Please fill in the Credit Card payment   below.
                                                                               section below)

Detailed Business Description:                                                 Credit Card Payment Details:
                                                                               Company name:
                                                                               Card holder’s name:
                                                                               Card type:        MasterCard              Visa         Maestro            Solo
                                                                               Amount payable:               £186.16               £281.86          £352.36
                                                                               Card number:
                                                                               Start date:                                      Expiry date:
Do you import?                          Do you export?
                                                                               Issue number: (If applicable)                    3 digit security code:
If you export please name the main countries that you export to:
                                                                               Membership Confirmation - Please Sign:
                                                                               Yes, we wish to apply for an annual membership to the Mid Yorkshire Chamber of
                                                                               Commerce and Industry, and agree, subject to election, to abide to the terms and
Please Select your Company Structure:                                          conditions as given in the Memorandum and Articles of Association, including 1
                                                                               month notice of termination required to cancel membership.
Sole Trader      Partnership      Private Limited Company          Start Up
                                                                               Signed:                                                Dated:

                                                                               Data protection
If you do not wish your company’s details to appear in the Chamber Directory   The information provided will be held on the Chamber’s computer database, which is regis-
please tick                                                                    tered under the Data Protection Act 1988. Information from the database may be supplied to
                                                                               third parties for the purpose of identifying potential trading partners, and you may be con-
                                                                               tacted by recipients of such information. You have the right to examine the data held on your
        Please fax back to 01484 483699 or post to:                            company. If you wish the details you have supplied not to be used for any purpose other than
                                                                               internal administration please tick
 The Stable Block, Lockwood Park, Huddersfield, HD4 6EN

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