New Member Application

First Name *

Surname

Email *

Password *

Role within your business *

Phone *

Mobile

Fax

Business

Others in my company/organisation are already members ($ 100 + gst/year)

Business
New to the Kapiti Chamber (or re-joining, $150 + gst/year, first person)

Business Name *

Address *

Suburb *

Region *

Postcode *

Country *

Phone *

Website *

Industry Code *

No of Full Time Equivalent Staff *