Deep River & District Chamber of Commerce
P.O. Box 1227
Deep River, Ontario
K0J 1P0

2009 Membership Application

Name of Organization: _____________________________________________________

Address: ________________________________________________________________

Business Phone: __________________________________________________________

Home Phone: ____________________________________________________________

Fax: ___________________________________________________________________

Email: __________________________________________________________________

 Representative                   Membership Fees
_____________                   ______________

Total Membership Fees: ______________

Please note one vote per paid representative.

Number of Representatives         Membership Fees Paid           Number of Votes
                1                                       $50.00                             1
                2                                       $95.00                             2
                3                                       $145.00                           3

Please remit payment to:
Deep River & District Chamber of Commerce
PO BOX 1227
Deep River, Ontario
K0J 1P0