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2 MEMBERSHIP APPLICATION Date: Please fill out the following information as you would like it to appear in the membership directory: COMPANY NAME: CONTACT NAME(S): PHYSICAL ADDRESS: MAILING ADDRESS: PHONE: FAX: WEBSITE: # of Employees *An employee is defined as a person who works 20 hours or more per week and is not a seasonal employee* BUSINESS PROFILING INFORMATION As a valued member of the Dauphin & District Chamber of Commerce we would like to offer you another venue of advertising for your business at no extra cost to you. Please fully complete the following for your advertisement to be added to our website as well as a possible commercial on CKDM. BRIEF HIGHTLIGHTS OF YOUR BUSINESS (WORDED EXACTLY THE WAY YOU WOULD LIKE IT ON THE WEBSITE).

3 Why are you a Chamber member? What do you consider the value of being a member of the Chamber of Commerce? MEMBERSHIP INFORMATION The Dauphin & District Chamber of Commerce strives to keep you up-to-date. Information on Chamber events, benefits and activities is published as required. To assist us in building your communication profile, please check your preferences below: Do you consent to being contacted with information regarding the Dauphin & District Chamber of Commerce electronically? (We send out a weekly newsletter, Chamber Matters, every Friday, and other messages as necessary.) Would you like to contribute articles for our weekly newsletter? Would you like to be included in our Chamber Bucks Gift Certificate Program? Please Note: Your business will be listed on the Manitoba Chamber of Commerce and DDCC online business directories. If you have any objections to this, please or fax in a request letter to remove your name from the directories. For any inquiries, please contact the Chamber office at: 100 Main St. South Dauphin, MB R7N 1K3 PHONE: FAX: coordinator@dauphinchamber.ca Our mission is to be a catalyst, to foster and encourage a progressive business environment through networking, promotion, education programs, tourism, and lobbying on behalf of membership.

4 MEMBERSHIP RATES Category Yearly G.S.T. Total Small: 1~3 Employees $ $7.25 $ ~10 Employees $ $10.00 $ Medium: 11~16 Employees $ $13.75 $ ~25 Employees $ $16.50 $ Large: 26~40 Employees $ $20.00 $ ~55 Employees $ $22.50 $ & Over $ $26.00 $ Non-Profit $90.00 $4.50 $94.50 Individual Citizen $90.00 $4.50 $94.50 Out of Town Business $90.00 $4.50 $94.50 Family Farm (non-corporate) $90.00 $4.50 $94.50 Affiliate Membership Each additional listing or business owned by the same individual, partnership or corporations may join as an Affiliate at a discount of half the cost of the applicable membership level with the primary membership being the largest of the businesses memberships.

5 The top 10 list you must read before you buy group benefits for your business The Chambers of Commerce Group Insurance Plan is Canada s #1 plan for small-to-medium businesses, delivering more benefits for you and your company. Here are 10 top reasons 20,000 firms like yours are already covered. 1. This program has no industry restrictions. All for-profit businesses are guaranteed eligible while they are Chamber members. Not-for-profit organizations are also considered, on a case-by-case basis. 2. Your firm customizes its plan from a wide range - and many levels - of coverage, from Life and Disability, to Health, Dental, and even Critical Illness benefits. That lets you control coverage and cost! 3. You can include employee-paid products in your plan, from optional life insurance for employees and spouses, to retirement savings. 4. Your Chambers Plan coverage is guaranteed to continue as long as your firm pays its premium each month. With three or more full-time people, your firm can even choose options that guarantee coverage to each person. 5. This program averages the claims it pays each year over thousands of customers. Rates are based on this pooled average, providing you with more stable premiums from year to year. 6. And those claims are paid promptly and accurately: health and dental payments are typically on their way to you within 48 hours. 7. The Chambers Plan gives you my-benefits, exceptional administration software. You have the option of running your plan on-line, anywhere, any time. 8. Claim forms, booklets and administration instructions are clearly written and easy to use. The National Service Line offers firms and employees toll-free access to Plan information from anywhere in Canada. 9. The Plan is run under the direction of a not-for-profit organization (the Chambers Insurance Corporation of Canada), so premiums are set to cover the cost of benefits and administration. 10. The Chambers Plan delivers quality group insurance plus these value-added services, without additional charge o Best Doctors gives employees and their own physicians access to world-class medical advice, to confirm the diagnosis of serious conditions and plan the most effective treatments. o The plan s Long Term Disability options include Confidential Telephone Coaching to help owners and supervisors deal with difficult personnel issues, plus counseling for employees receiving disability benefits. o Health options include Preferred Vision discounts on eyewear purchases and Health Access Line, staffed by experts ready to answer questions about health, nutrition, and regional health resources. So how many reasons do you need? Whether you re introducing or replacing a program, get all the benefits of the best group plan. Call the Chambers Plan today. To speak with the exclusive Chambers Plan Representative, fax back this form or call. Please print: Company Name Your name & position Postal Code Numbers of Employees _ Phone Fax CONTACT: Scott Whitmore PHONE: FAX: