Member Registration Form

Annual Membership Fees

PRIVATE SECTOR	1-5 employees	$125
	6-10 employees	$150
	11-30 employees	$250
	31+ employees	$425
GOVERNMENT	Population under 10,000	$125
	Population over 10,000	$250
	Population over 100,000	$500
STEWARDSHIP AGENCIES		$250
NON PROFIT	1 Full time employee	$75
NON PROFIT	More than 1 full time employee	$125
FLAT RATE FEES FOR REGIONAL DISTRICTS LOCATED WITHIN AVICC CATCHMENT AREA	Population 0-10,000	$250
	Population 10-20,000	$500
	Population 20-50,000	$750
	Population 50-100,000	$1,500
	Population 100,000+	$3,500

Pay Securely with the Credit Card form below, or access our printable version and fax or mail to CWMA with payment.

Registrant Information

First Name

Last Name

Title / Position

Organization

Address

City

State / Province

Country

Postal / Zip Code

Phone #

(10 digits no dashes)

Website

Please Add up your Total Membership Fees based on the pricing table above.
Tax/GST will be added Automatically (All Registrations Fees will be verified)

Total Fees

Tax/GST + 5%

Total Payment Amount

Payment Type

Please check this box if you would prefer an invoice for cheque payment.

Name on Card

Required

Card Number

Valid Visa, Master Card required

Expiry Date

CVV/CVC Number

Required

3 to 4 Digit Security # on back of card