Online Membership Application Membership Application Name* First Last Designations (Type N/A if not applicable)*Position*Company*Email* Business Address* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Business Phone*Business Phone ExtensionHome Address* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Home Phone*Birth Date* I Am:Please select all that apply Willing to serve on a committee Not willing to serve on a committee Willing to chair on a committee Not willing to chair on a committee What year did you first become a member?*Please enter a value between 1900 and 2100.Have you ever attended a National CAIW Convention?* Yes No Membership Payment*Invoice Me (Full Membership)Credit Card (Full Membership)Invoice Me (Associate Membership)Credit Card (Associate Membership)Total $ 0.00 CAD Credit Card MasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
