Company name (as it should appear in directory)

Phone number (for directory):

Contact name:

Address:

City:   

Postal code:

Fax number:

Email:

CATEGORIES (please check all that are applicable - first category is $30 per year, each additional is $10 per year)

Method of payment:

Cheque being sent

Bill us next June

THANK YOU VERY MUCH FOR YOUR SUPPORT