COMTA MEMBERSHIP APPLICATION


If you would prefer to send your membership application via postal mail, please fill out this form and print it using your browser's 'Print' option. If paying by credit card, include your credit card information If you prefer, you may fax this form to . If paying by cheque, include the cheque with the printed copy of the form. Mail the completed form to:
      C.O.M.TA.
      #207, 1150 - 100 Ave.
      Edmonton, Alberta
      Canada
      T5K 0J7


Professional Designation:
If other:
Family Name:
First Name:
Address 1:
Address 2:
City:
Province/State:
Country:
Postal Code/Zip:
Phone:
Fax:
Email:


Membership Fee: $100.00 CDN (includes provincial registration)

Yes, I would like a business receipt issued.

I am a paid CAMT member (CAMT will pay my fee)

Enclosed is my payment (payable to C.O.M.T.A.)
   Send cheque with completed application form.

Please charge my
    VISA
    Mastercard
    AMEX

Cardholder's Name:
Card Number:
Card Expiration Date:



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