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Personal Information


Salutation:		Name:		Designation:

Street Address:

City:	Province/Territory:	Postal Code: A#A #A#

Phone: ###-###-####		Fax: ###-###-####		Email:

Organization Information


Organization Name:		Position/Title:

Street Address:

City:	Province/Territory:	Postal Code: A#A #A#

Phone: ###-###-####		Fax: ###-###-####

Additional Information

Consent for Collection, Use and Disclosure of Information

By selecting yes, I consent to the collection, use and disclosure of my personal information during the course of my membership for the purposes set out in the AFOA Canada Policy, a copy of which is available on the AFOA Canada website.

By selecting no, I consent to the use of my personal information only for the purpose of permitting AFOA Canada and/or AFOA Chapters to communicate with me.

Yes No

Payment

A condition of membership in AFOA Canada requires all applicants to join the AFOA Chapter located in the applicant's territory where one exists. AFOA Chapters are currently in operation in Alberta, Atlantic, British Columbia, Manitoba, Northwest Territories, Ontario, Quebec and Saskatchewan. The membership year runs from January 1 to December 31. To join AFOA Canada and the applicable AFOA Chapter, please provide the following information:

For National Corporate Memberships, please complete the Corporate Membership Application.

Membership Fees:	$

Subtotal:	$

5% GST*:	$	13% HST for Atlantic Provinces GST on BC dues - see note above

Total Amount Due:	$

Method of Payment:
Cheque (payable to AFOA Canada)
VISA
Mastercard
American Express

Please send cheques to the following address:

AFOA Canada
1066 Somerset Street West, Suite 301
Ottawa, ON K1Y 4T3

Credit Card Information (if applicable):

Cardholder Name:

Credit Card Number:

Expiry Date:

* Please provide proof of GST tax exemption at time of application


Send correspondence to: Home Organization		Optional: First Nations Métis Inuit Non-Aboriginal

Chapter Fees: Alberta Member $275 Student Member $25 Retired Member $30 Elder Member $25 Corporate Member $1,000 Atlantic* (NB, NL, NS, PEI) Member $300 Student Member $25 Retired Member $30 Elder Member $25 British Columbia* Member $400 Student Member $25 Retired Member $30 Elder Member $25 Manitoba* Member $250 Student Member $25 Retired Member $30 Elder Member $25 Corporate Member $750 Northwest Territories* Member $275 *Student Member $25 Retired Member $30 Elder Member $25	Ontario Member $300 * Student Member $25 Retired Member $30 Elder Member $25 Corporate Member $750 Quebec Member $250 Student Member $25 Retired Member $30 Elder Member $25 Saskatchewan* Member $250 * Student Member $25 Retired Member $30 Elder Member $25 Corporate Member $750 Yukon, Nunavut Member $150 *Student Member $12.50 Retired Member $15 Elder Member $12.50
* Student Membership: for individuals who are enrolled full-time in high school or post-secondary education. Please attach proof of student status with you application and annually at time of membership renewal.

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