Disclaimer

The information collected below will be shared with Leduc County for the purposes of administering municipal services and emergency response.

Business Location *

Nisku

Edmonton International Airport

Elsewhere in Leduc County

Business Operating/Legal Name *

Physical Operating Address of Business

Address Line 1 *

City *

Postal Code *

Mailing Address (if different than above)

Address Line 1

Address Line 2

City

Province

Postal Code

Business Owner Name *

Owner Phone Number *

Website

Business Main Contact Name (if different from Business Owner) *

On-site/Emergency/All Hours Contact

Business Main Contact Phone # *

How many Employees does the business currently have? *

E-mail Address *

What year was the business established in Leduc County? *

Description of Business (Products, Services, Operations, Keywords, etc.) *

Please list any & all Hazardous Materials used/stored at Business Location (for emergency services) *

This Business is Involved in Exporting or Importing *

Yes

No

I consent to *

have my business/business contact information shared with Leduc County for the purpose of administering municipal services and emergency response.

Yes

No

I consent to receiving Chamber communications *

Yes

No

I would like *

to receive email information about economic development and/or public participation opportunities from Leduc County.

Yes

No

Date *

Additional Comments