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905-387-1883
1-877-330-3384
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People in Connection Membership Application Form

We accept Mastercard, Visa and Paypal through our secure interface provided by Paypal.com (NOTE: you do not need to be a member of Paypal to order online). If you prefer to pay via cheque, please fill in the application form and indicate that you will send along a cheque and your invoice will be sent to you. (listing will not be posted until payment is received)

Business Name
First Name
Last Name
Mailing Address
Make Address Public	YES   or No
City
Province	Ontario Alberta British Columbia Manitoba Newfoundland & Labrador New Brunswick Nova Scotia Prince Edward Island Quebec Saskatchewan Nunavut Northwest Territories Yukon
Postal Code
Phone
Make Phone Public	YES   or No
E-mail
Make E-mail Public	YES   or No
Membership Level	Basic - $75 Expert - $199 Advertising - $399 Prime Advertiser - $999 Registered Charity - $0
Registered Charities Enter your org. number
Optional Add-ons for members at the advertiser or prime advertiser levels.	Expert Category ($75) Top of Category Banner Ad ($125)
Category Name	--- Please Select Category --- Accounting & Bookkeeping Advertising Aesthetic Services Alterations Art Galleries Artists Audio,Video, Satellite - Sales and Service Authors & Story Writers Bakeries Beauty & Skin Care Products Business Network Groups Business Opportunities Business Skills and Career Training Carpet Cleaning Catering Service Charities Charities - Animal Services Charter & Cruises Churches Coaching - Business & Corporate Coaching - Personal Computers- Sales & Service Counselling Services Custom Furniture Digital Presentations Entertainment Environmentally Friendly Products & Services Financial Divorce Specialist Financial Services Food and Beverage Wholesale/Retail Framing Products & Services Garden Centre Graphic Design Firms Health and Wellness Hobbies and Crafts Home Parties Insurance Interior Decorating and Design Jewelry Sales Legal Services Locksmithing & Security - Residential & Commercial Manufacturing - Plastics Material Handling - Products & Services Mediation Services Moving and Storage Music - Schools & Lessons Nannies Newspapers Office Furniture and Design Photography Physicians or Surgeons Plumbing & Heating Services Professional - Organizing Services Professional - Speakers Promotional Products Property - Rental Services Psychics Real Estate - Agents Restaurant Retail - Sports Memorabilia Roofing Secretarial Services Seniors - Caregivers Shopping - Services Speech Therapists Tourist Attractions Travel and Tourism Video & Internet TV Production Virtual Assistant Web Design - Programming Web Design Services
Page Title - Keywords 5 - 7 keywords or keyword phrase for your business for search engine visibility	example: web design, advertising, internet services, network Hamilton,
Web Site Address
Description Max 1000 characters	characters left
Referred by
Home Chapter	Bancroft Brantford Burlington Caledonia Cambridge Hamilton London Oakville Peterbourgh Renfrew St. Catharines
I plan to submit the following items while a member INCLUDED	Articles Events News Specials Did You Know
If this is a second business membership you are submitting, please provide the name the first business already on our database to receive 25% discount (If you are registering another business, please make sure you use a different email address for your new registration. Your email address becomes your username to login and update your business information.)
I am interested in more information about:	Web Site Design Web Site Promotion Graphic Design TV Show Sponsorship Micro-ad Spaces Event Sponsorship Chapter Leadership
I wish to be on the Show!	YES   or No

Questions? We can be reached at:

Local to Hamilton 905-387-1883
TF: 1-877-330-3384
or

General inquires or information e-mail: Marie Mushing
Web site design inquiries e-mail: Chris Mushing

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