CHRA - Membership Application

If you have any questions about this form or the registration process, please contact Vicky Coulombe-Joyce at 613.594.3007 ext. 19 or e-mail info@chra-achru.ca

Download the PDF | View the fees

Contact Information:

Organization Name:

* First Name:

* Last Name:

(Contact person will be the representative with voting privileges)

Mailing Address:

Street Address:

City:

Province:

Postal Code:

* Email Address:

* Phone No.:

Fax No.:

Membership Category: *

Click here for membership category descriptions and fee schedules.

Enter the text above.

* denotes a mandatory field.