Please provide the following information:

First Name
Last Name
Title
Organisation
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

What is your position within your organisation?

What is your trade/profession?

Number of Employees:

0-1 2-4 5-9 10-25 26-50 51-100 101-150 151-200 201-300 300+ Charity

What is your organisations legal format:

Sole Trader
Partnership
Private Company
PLC
Charity

If your company is part of a larger group please state your parent company name:

How would you like to receive your monthly newsletter?

By Email
By Post

If you would like to receive your newsletter by email please state the email address that you would like to use:

Please confirm that email address again:

How would you like to pay for your membership fees?

Cheque
BACS
Standing Order

The organisation I duly represent is an existing town member and I wish to claim my 'dual membership' discount:

Yes No

As part of your membership you receive exclusive access to our Business Forum, which offers many facilities to you as a member. Which user name would you prefer to use?

Your Company Name
Your Private Name

As a member you automatically get listed in our members directory, which includes a link to your website. We do however offer a 'profile page', which is a page dedicated to your business. You can place information detailing images and text, full contacts and extended web information, company structure, products etc. To cover the cost of your company profile design we ask for just £35 + vat. If you would like to take this option please state here:

Yes No

If you wish to offer discount or any other concession for other Somerset Chamber members please outline here what these may be:

Please confirm that you understand and agree to the following statement: On behalf of, and as a duly authorised representative of, the above name business, I hereby apply for a membership of Somerset Chamber of Commerce & Industry Ltd. I fully understand that this form is purely an application for membership and does not constitute a membership until I have paid the fees due. I also understand that if I/we wish to terminate my/our membership I must give notice of at least 30 days.

Yes No

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