Associate Member Application Form "*" indicates required fields Choose Your MembershipOrganization Revenue* Organization under $100 000 of revenue Organization between $100 000 and $249 999 of revenue Organization between $250 000 and $499 999 of revenue Organization between $500 000 and $999 999 of revenue Organization between $1 000 000 and $2 499 999 of revenue Organization above $2 500 000 of revenue Membership Level Associate Membership: Tier 1 ($75 /year) Membership Level Associate Membership: Tier 2 ($245 /year) Membership Level Associate Membership: Tier 3 ($495 /year) Membership Level Associate Membership: Tier 4 ($995 /year) Membership Level Associate Membership: Tier 5 ($2,495 /year) Membership Level Associate Membership: Tier 6 ($4,995 /year) Create Membership AccountEmail* Password* Enter Password Confirm Password Contact InformationName* First Last Organization Mobile Phone*Date of Birth (mm/dd/yyyy) MM slash DD slash YYYY City* Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code* Additional InformationWhich region do you best represent?Atlantic Region (NS,NB,PEI,NFD)British ColumbiaCanada North (YK,NWT,NVT)OntarioPrairie Region (AB,SK,MB)QuebecN/AI am an indigenous Canadian No Yes Review & Online PaymentMembership Level: Associate Member Tier 1 – $75.00 (CAD) Subscription period: 1 yearMembership Level: Associate Member Tier 2 – $245.00 (CAD) Subscription period: 1 yearMembership Level: Associate Member Tier 3 – $495.00 (CAD) Subscription period: 1 yearMembership Level: Associate Member Tier 4 – $995.00 (CAD) Subscription period: 1 yearMembership Level: Associate Member Tier 5 – $2495.00 (CAD) Subscription period: 1 yearMembership Level: Associate Member Tier 6 – $4995.00 (CAD) Subscription period: 1 yearTotal Amount Due Billing AddressAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Payment InformationCredit Card*Card Details Cardholder Name