Application for Annual Membership

First Name

Last Name

Email

Phone Number

Company

Gender Please make a selection Male Female Would Rather Not Say Unknown

Age Please make a selection 16-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-Plus Prefer Not To Say Unknown

Disability Please make a selection Yes No Prefer Not To Say Unknown

Ethnicity Please make a selection White British White Irish White Other British Other Mixed White and Black African Mixed White and Black Caribbean Mixed White and Black Asian Asian or Asian British Chinese Caribbean or African Black or Black British Unknown Prefer Not To Say

Company Registration Number (CRN) or Unique Tax Reference (UTR)

SIC Code (applies to Companies House Registered Businesses only)

Charity Number if registered

Address Line 1

Address Line 2

Town

County

Postcode

Description of Business

What sector does your business operate in? Please make a selection Accomodation and Food Service Activities Activities of Extraterritorial Organisations and Bodies Activities of Households as Employers, Undifferentiated goods and services producing activities of households for own use Administrative and Support Service Activities Agriculture, Forestry and Fishing Arts, Entertainment and Recreation Construction Education Electricity, Gas, Steam and Air Conditioning Supply Financial and Insurance Activities Human Health and Social Work Activities Information and Communication Mining and Quarrying Manufacturing Professional, Scientific and Technical Activities Public Administration and Defence, Compulsory Social Security Real Estate Activities Retail Service Activities Transportation and Storage Water Supply, Sewerage, Waste Management and Remediation Activities Wholesale and Retail Trade, Repair of Motor Vehicles and Motorcycles Other Service Activities

Website

Social Media Handles

Is your management structure more than 51% women led?

Is your management structure more than 51% disabled-led?

Is your management structure more than 51% ethnic minority-led?

Grade Applying For Please make a selection Bronze £118.80 (£99 ex VAT) Bronze Plus £238.80 (£199 ex VAT) Silver £298.80 (£249 ex VAT) Gold £478.80 (£399 ex VAT) Platinum £958.80 (£799 ex VAT) Not Sure

Number of Employees Please make a selection 1 - 5 6 - 9 10 - 49 50 - 249 250 - 500 500

Turnover Please make a selection <£2 million £2m - £10million 10m - 50million >£50million

Are you or have you ever been a member of Newham Chamber of Commerce before?

Yes

No

Are you interested in becomming a member of the Executive Committee? Please make a selection Yes No Not Sure

Do you have any special offers to share with other chamber members?

Do you agree to join our members benefit scheme and share your special offers with other members? Please make a selection Yes No Not Sure

Do you agree to join our members directory posted on our website? Please make a selection Yes No Not Sure

Would you like to use our portal to get your invoices and communications? Please make a selection Yes No Not Sure

How did you hear about us? Please make a selection Newham Chamber Website Newham Chamber Networking Event Newham Chamber Women In Business Newham Chamber Skills Group Newham Chamber Newsletter Word of Mouth via an existing NCC Member FSB Referral Meet The Buyer Event Newham Recorder Other Newspaper Us and Co Tenant or Event Newham Business and Enterprise - E-Newsletter

Ward in Newham (if known)

I agree for the Newham Chamber of Commerce to invoice me for my annual membership renewals, after my first year of membership

I confirm I have read Privacy Statement

I confirm I have read Terms and conditions

Please write your signature here
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