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Refer a Member/Potential Member

Notify your Chambers Plan Advisor of a member/potential member that may be interested in the Chambers of Commerce Group Insurance Plan

Should Chambers/Boards of Trade come across members or potential members interested in learning more about the Chambers of Commerce Group Insurance Plan benefits offered exclusively through their organizations, simply fill out the form below. Your local Chambers Plan Advisor is automatically notified and will contact the organization as soon as possible.

  1. Referrer Information

  2. Chamber
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  3. Name of Individual Making Referral
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  4. Your Phone Number
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  5. Comments
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  6. Member/Potential Member

  7. Name
    Please enter a contact name.
  8. Company Name
    Please enter the company name.
  9. Number of Employees
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  10. City
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  11. Phone Number
    Please enter a valid phone number.
  12. Email
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  13. Postal Code(*)
    Please enter a valid postal code in the A1A 1A1 format.
  14. If unknown,please use the Postal Code for your Chamber/Board of Trade.

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