Membership Application - Public Subscriber

Contact Info

Prefix

First Name *

Last Name *

Email (Personal) *

Organization/Employer

Phone *

Phone (Cell)

Fax

Secondary Email (Work) *

If you don't have a second email, enter the same email address twice.

Street Address *

City *

Province / Territory *

Country *

Postal Code *

Street Address

City

Province / Territory

Country

Postal Code

Address to be listed on invoice *

Preferred address to receive mail *

Opt out of third party mail? *

How did you hear about us?

I certify that the information I have provided on this form is correct, and that I am eligible for the membership category for which I am applying *

I certify that I understand that subscription and membership fees (if applicable) are non-refundable *

Yes, please include annual Canadian Institute of Planners (CIP) membership on my invoice.