CASIS Membership Application

 

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__________________________________

                                               

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):     

 ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

 

Phone: (Home)______________________ (Business)________________________

 

E-Mail:_______________________________________________________________



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

                         YES                   NO

 

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

 

Date: ______________________Signature:__________________________________