Join
APPLICATION
Registration form
Burrum Chamber of Commerce membership
Information required of applicant as per below
1…Full name and address of business owners
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Name |
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Address ………………………………………………………………………………………………. |
2…Contact phone numbers including mobile and fax
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PH.………………….. FAX……………………. M……………………………………….. |
3…Email address and any web site addresses
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Web ………………………………………………………………………………………………. |
4…ABN # or Business registration # Business name, location, PO Box
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ABN#………………….. BRN#……………. PO Box ……….@……………..PC…….. |
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Location ………………………………………………………………………………………………. |
5…Photos – up to five. Personal photos + of business activities/products
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CURRENT MEMBERSHIP FEE FOR THE YEAR IS $40
MEMBERSHIP
*Registration entitles member to a profile page on the web site complete with photo and business details
Signed by applicant
…………………………………………………………………Date……./……./……….
Regards
Henry Sapiecha 
Publicity Officer
Burrum Chamber of Commerce