Membership Application Form
* Required
Business Name *
Your answer
ABN
Your answer
Industry *
Your answer
Business website
Your answer
Business Details
Telephone
Your answer
Business Street Address
Number and Street *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Postal Address
Number
Please leave blank if the postal address is a PO Box
Your answer
Street or PO Box details *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Contact Details
Primary Contact
First Name *
Your answer
Surname *
Your answer
Telephone
Your answer
Email Address *
Your answer
Secondary Contact
First Name
Your answer
Surname
Your answer
Telephone
Your answer
Email Address
Your answer
Chamber Alliance Partner Program
As a member of the Lithgow District Chamber of Commerce you are entitled to a FREE Local Chamber Membership package with the NSW Business Chamber including access to a range of additional business tools and resources. If you would like to 'opt in' to be part of this program, please tick the 'opt in' box above.

By selecting to 'opt in' above, I, the above named and being a financial member of the Lithgow Chamber of Commerce hereby agree to apply for the Local Chamber Limited Membership of NSW Business Chamber ("NSWBC") as part of the Alliance with our Local Chamber, and agree to be bound by the NSWBC constitution and terms and conditions as amended from time to time and available on the NSWBC website at www.nswbusinesschamber.com.au/termsandconditions.

I understand and agree that membership of the NSWBC is for a period of 12 months and the renewal of our membership for further periods of 12 months each is subject to our Local Chamber renewing the Local Chamber Alliance Agreement with NSWBC each year and our business continuing to be a member of our Local Chamber. I understand and agree that our NSWBC membership benefits and entitlements may vary by agreement between the NSWBC and our Local Chamber.

Other
Disclaimer
1. Once your membership application is received, an invoice will be issued to the primary contact.

2. Membership is confirmed once your completed application form and payment has been approved at the Management Committee meeting.

3. Membership approval is at the discretion of the Management Committee.

4. If the membership application is not approved, payment will be refunded.

5. [Membership]

6. Prior to your annual membership renewal, an invoice will be sent to the primary contact which is payable prior to the membership expiry date.

7. Membership may be cancelled if payment is not received within 30 days of the membership renewal date.

8. Should you cancel your membership at any stage during your membership year; a refund will not be given.

9. Your membership is corporate and is non-transferable.

10. You must notify our Member Services Officer of any changes to your contact details by letter or email to ensure your membership benefits are available to you.

11. You agree to receiving information relevant to this membership in electronic format.

12. Changes to our annual membership fee structure will take effect on 1 January each year.

13. We reserve the right to alter the services available to members at any time.

14. Changes to this Disclaimer are made at the discretion of the Management Committee and may be made without prior written notice to existing members. Changes will be posted on the website.

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