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Payee Information

First Name

Last Name

Company/Organization/Individual

Email Address

A confirmation email will be sent to this address

Daytime Phone Number

Membership Type Not a memberCorporateIndividual VotingCommunity AssociationNon-Voting

Payment Amount

Amount Individual Non-Voting: $25Individual Voting or Community Association: $100Corporate: $200

Invoice Number

Other Information

Comments

Payment Information

Name on Card

Please enter the name exactly as it is shown on the credit card

Card Type VISAMasterCard

Address

City

Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Territories

Postal Code

Credit Card Number

Expiry Month 010203040506070809101112

Expiry Year 20182019202020212022202320242025202620272028

CSV

This is the 3 digit number on the back of your credit card