Application Form

Wednesday, February 22, 2012

Electronic Membership Application Form

MEMBERSHIP APPLICATION All information given on this form is strictly confidential. Please supply as much support documentation as possible, including your resume. Submit the application to the Canadian Institute of Marketing office at 205 Miller Drive, Halton Hills (Georgetown), ON L7G 6G4, Canada. Please print or type the information submitted on the form.
I hereby apply for election to membership of the Canadian Institute of Marketing on the basis of theinformation provided in this form and agree to accept the decision of the Registrar. I enclose theapplication processing fee ($CAD50) and agree to remit the annual membership subscription on demand.

Given Name		Family Name

Home Address		Business Name and Address

Home Telephone		Home Email

Position in Company		Date appointed

Marketing Responsibility		To whom do you report?

Number of Marketing Staff reporting to you		Marketing budget responsible ($CAN)

Briefly describe your marketing responsibility		Degrees/Professional Qualifications

Name other marketing associations of which you are a member		Membership in Professional Organisations
Experience

Submit


Contact - Canada Post - Telephone - Email Mail 205 Miller Drive Halton Hills (Georgetown) • Ontario • L7G 6G4 • CANADA T: 905•877•5369 info@professionalmarketer.ca