MEMBERSHIP APPLICATION FORM 2009

Company name:

Representative's name:

Address:

City (Province):

Zip Code:

Web site:

Email:

Telephone:

Fax:

Description of goods and services:

Membership status:	Membership dues: #QST (7,5%):1006106711 #GST (7%): R106731128	Amount included
Regular supplier member:	1,000$ + taxes
Privileged supplier member:	1,500$ + taxes