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Membership Application Form (Membership Valid From January to December) Become a New MemberRenew my Membership Member Information Member Name* Adress* Postal Code* Country* City* Province/State* Sector* Industry* Website* Company Services and Products* Representative Information First Name* Last Name* Job Title* E-mail* Phone* Mobile* Adress* Postal Code* Country* City* Province/State* Communication Opt-in BCCC Communications are e-mail, invitations, surveys and a e-newsletter Yes! I want to receive BCCC communicationsNo. I am not interested. I authorize the BCCC to include my company’s name and contact information in the BCCC’s website * Required Fields Membership & Sponsorship Application Form Membership Category 2 Year Membership (10% discount)1 Year Membership Prices are subject to applicable taxes | BCCC HST/GST number: 895651743 BCCC Partner Member (Investment: Leading or Corporate + $2,500 + Event Cost per year)BCCC Leading Member (Investment: $7,500 per year)BCCC Corporate Member (Investment: $5,000 per year)BCCC Small Business Member (Investment: $1,200 per year)BCCC Education Institution Member(Investment: $1,500 per year)BCCC Start-Up Member (Investment: $500 per year)BCCC Individual Member (Investment: $500 per year) Sponsorship Category 1 Year Sponsorship3 Year Sponsorship (10% Discount) BCCC Platinum Sponsor (Investment: $10,000 per year)BCCC Gold Sponsor (Investment: $7,500 per year)BCCC Silver Sponsor (Investment: $5,000 per year) Payment Methods Cheque Please mail your cheque attached to this application form. See mailing procedure below. Payable to: Brazil - Canada Chamber of Commerce Adress: 401 Bay Street, 16th Floor, Mailbox #14 Toronto ON, M5h 2Y4 Canada Payment by Wire Transfer Bank Name: TD Canada Trust Bank Address: BCE Place, 161 Bay Street Toronto ON, M5J 2T2 Bank Account #: 05005230818 Transit Number #: 05002 Financial Institution #: 004 Bank Swift Code: TDOMCATTTOR Credit Card Select your card type VisaMastercardAmex Card Number: Expiry Date: Name on Card: CSC: Billing Address: Authorization By checking this box, I acknowledge the charges described hereon. Payment in full to be made when billed or in extended payment in accordance with standard policy of Company issuing card.
Member Information
Representative Information
Communication Opt-in
BCCC Communications are e-mail, invitations, surveys and a e-newsletter
Yes! I want to receive BCCC communicationsNo. I am not interested.
I authorize the BCCC to include my company’s name and contact information in the BCCC’s website
* Required Fields
Membership Category 2 Year Membership (10% discount)1 Year Membership
Prices are subject to applicable taxes | BCCC HST/GST number: 895651743
BCCC Partner Member (Investment: Leading or Corporate + $2,500 + Event Cost per year)BCCC Leading Member (Investment: $7,500 per year)BCCC Corporate Member (Investment: $5,000 per year)BCCC Small Business Member (Investment: $1,200 per year)BCCC Education Institution Member(Investment: $1,500 per year)BCCC Start-Up Member (Investment: $500 per year)BCCC Individual Member (Investment: $500 per year)
Sponsorship Category 1 Year Sponsorship3 Year Sponsorship (10% Discount)
BCCC Platinum Sponsor (Investment: $10,000 per year)BCCC Gold Sponsor (Investment: $7,500 per year)BCCC Silver Sponsor (Investment: $5,000 per year)
Payment Methods
Cheque Please mail your cheque attached to this application form. See mailing procedure below.
Payable to: Brazil - Canada Chamber of Commerce Adress: 401 Bay Street, 16th Floor, Mailbox #14 Toronto ON, M5h 2Y4 Canada
Payment by Wire Transfer
Bank Name: TD Canada Trust Bank Address: BCE Place, 161 Bay Street Toronto ON, M5J 2T2 Bank Account #: 05005230818 Transit Number #: 05002 Financial Institution #: 004 Bank Swift Code: TDOMCATTTOR
Credit Card Select your card type
VisaMastercardAmex
Authorization
By checking this box, I acknowledge the charges described hereon. Payment in full to be made when billed or in extended payment in accordance with standard policy of Company issuing card.
