Online Membership Applications

Membership Type *

Active ($136.00)
Associate ($136.00)
Educational ($99.00)
Retiree ($50.00)
Student ($0.00)

Title

First Name *

Last Name *

Email *

Organization

Position

Address Line 1 *

Unit/Suite

City *

Province *

Country *

Postal Code *

Phone *

Fax

Website

Owner

Secondary Email

Medium

Radio
Television
Digital

LinkedIn Profile

X Handle

Would you like to volunteer on a committee

Would you like to Judge Regional or National Awards

Electronic Correspondence *

I agree to receive electronic correspondence
I DO NOT wish to receive any electronic correspondence

Subtotal:

$0.00

Tax (GST/HST):

$0.00

Total:

$0.00

Discount Code:

Name on Card: *

Card Number: *

CVC: *

Expiration (MM/YYYY): *

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