Member

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

Province *

Please add your Province.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1

Address line 2

Country

City

Province

Postal Code

Social Network Addresses

Facebook

Twitter

Instagram

Step 2:

Additional Info

Directory Category

Full-time Employees

Part-time Employees

Reason for Joining? *

Looks good!

*Optional* Add your Pronouns

Are you a PEI Connectors Client? *

Looks good!

Are you interested in Chamber Group Health Plan? *

Looks good!

Are you interested in Point of Sale discounts? *

Looks good!

Are you interested in Office Supply Discounts? *

Looks good!

Are you interested in Automatic Renewal? *

Looks good!

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1

Address line 2

Country

City

Province

Postal Code

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1

Address line 2

Country

City

Province

Postal Code

Create Account

Password *

Please add your login password.

Step 5:

Comments/Questions

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Create Account

Step 5:

Payment Option