New Membership Application

Basic Information

Primary Language for correspondence (check one)*

Organization Name/Individual Name*

Mailing Address*

Street Address City Province Postal Code

Email*

Phone*

Name*

First Last

Position

Email*

Phone

Address (if different from organization)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

What is the focus of your organization (e.g. archaeology, museum, etc.)?

What are your organization's main activities?

How many employees does your organization have?*

Does your organization also have members?*

How many members?

Website

Logo

Accepted file types: png, jpg, jpeg, Max. file size: 8 MB.

Facebook page

Twitter feed

Other relevant webpages

Please provide the names and emails of all other people you wish to include for communications for CHC|CPC. (Ex. John Doe: [email protected])

We value your feedback, please let us know how we could improve your membership.

Please select one of the following memberships:*

Please check which option reflects your organization's annual operating budget to determine your corresponding membership fee.*

Please check which option reflects your organization's annual operating budget*

Donation

Total

$ 0.00 CAD

I will be paying by:*

Credit Card

Card Details

Cardholder Name