CASIS Membership Application

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Please print this form, then complete it and send along with a cheque or money order, payable to �CASIS�, to:

CASIS Secretariat, PO Box 71007, RPO L'Esplanade, Ottawa, Ontario, K2P 2L9

I wish to join in the following category (all amounts are in CDN$):
��� $35.00 - Regular Member;
��� $25.00 - Students; Student Number__________________________________

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Educational Institution_____________________________________________

��� $25.00 - Seniors (65 and over), Retirees.

A tax deductible receipt will be issued to Canadians paying their own fees.

I am renewing my membership. ��� I am a new member.

Name:________________________________________________________________

Address: (Please indicate whether home or business):     

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______________________________________________________________________

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Phone: (Home)______________________ (Business)________________________

E-Mail:_______________________________________________________________

I consent to my contact information being shared with other CASIS members.

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Contact information will not be shared without the consent of the individual.

Date: ______________________Signature:__________________________________

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