RETAILER MEMBERSHIP

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1 - Member / 2 - Contact / 3 - Fee schedule

Fields marked with an * are mandatory.

Company *

Other names used

Other corporate or store names under which the company operates

Indicate the number of establishments per province *

Quebec *	Ontario	Alberta	British Columbia	Prince Edward Island	Manitoba

New Brunswick	Nova Scotia	Saskatchewan	Newfoundland and Labrador	Yukon	Northwest Territories

Year founded

Number of full-time employees *

Number of part-time employees *

Please indicate your main sector of activity *

Enterprise category *

1 - Member / 2 - Contact / 3 - Fee schedule

Fields marked with an * are mandatory.

Title of courtesy*

Mr. Mrs. Miss Ms.

First name *

Last name *

Title *

Address *

Address 2

City *

Province *

Postal code *

Telephone *

(xxx-xxx-xxxx)

Telephone, extension

Fax

(xxx-xxx-xxxx)

E-mail *

Web site

Password *

Confirm your password *

Language of correspondence *

French
English

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