Membership Application

Pour toutes questions concernant ce formulaire ou l'inscription, veuillez contacter Vicky Coulombe-Joyce au (613) 594-3007 poste 19 ou envoyez un courriel à info@chra-achru.ca

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Contact Information :
Organization Name :
* First Name :
* Last Name :
(Contact person will be the representative with voting privileges)
Mailing Address :
Street Address :
City :
Province :	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code :
* Email Address :
* Phone No. :
Fax No. :
Membership Category : * Click here for membership category descriptions and fee schedules.
Affordable Housing Providers, Owners & Managers (Number of units :  *)  Provincial or Territorial Department  Associations & Networks (Number of members :  *)  Individual Member (regular rate)  Municipality (Population :  *)  Non-Profit Group  Business Partner  Individual Member (reduced rate)
	Enter the text above.

* denotes a mandatory field.