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Membership form for an organization
Identification
*First name

*Last name

*Email

*Occupation

*Telephone

Fax


Billing Contact

Same

Name

Email

Telephone

Occupation

Organization

*Type of organization?

*Organization's name

*Address

*City

*Country

*Province


*Postal Code

*Website

If billing address is different, Click here

Choose

Population - 0 to 500 135$/annual
Population of 501 to 1000 160$/annual
Population of 1001 to 2500 275$/annual
Population of 2501 to 5000 500$/annual
Population of 5001 to 10000 600$/annual
Population of 10 001 to 25 000 825$/annual
Population of 25 001 to 100 000 1100$/annual
Population of 100 001 + 1400$/annual
Federal and provincial governments 1400$/annual
Associations - Federations 550$/annual
Companies 550$/annual
Other 550$/annual

SUB TOTAL
PST
0.00
QST
0.00
TOTAL
0.00
Other information

P.O Number

Other relevant information (Maximum characters: 200)




 

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