ON-LINE "BE-A-JOINER" FORM

SELECT ONE OF THE FOLLOWING:
YES, I would like to be a corporate joiner!
MAYBE, but first send me more information.
DON'T GET EXCITED, I am already a member. Please update my file...


CORPORATE INFORMATION:
Company Name:
Address line 1:
Address line 2:
City:
Prov/State:
P-Code/Zip:
Phone:
Fax:
E-Mail:

CONTACTS:
Main Contact:
Title:
Phone:
e-Mail:
Contact 2:
Title:
Phone:
e-Mail:
Contact 3:
Title:
Phone:
e-Mail:
Contact 4:
Title:
Phone:
e-Mail:
Contact 5:
Title:
Phone:
e-Mail:
( if necessary, use box below for additional contacts)


INDUSTRY:
Manufacturing Finance Distribution
Service Vendor Consulting
Other, Specify:

QUESTIONS/COMMENTS (optional):


Corporate Membership: $495 plus $24.75 GST = $519.75
GST No. R136112430


BENEFITS OF MEMBERSHIP: