CIC Membership Form Formule d`adhésion au CIC To

CIC Membership Form
Formule d'adhésion au CIC
Calgary, Edmonton, Halifax, Hamilton, Montreal, National Capital (Ottawa),
Nipissing, South Saskatchewan (Regina), Saskatoon, Thunder Bay, Toronto,
Vancouver, Victoria, Waterloo Region, Winnipeg
6 Hoskin Avenue
Toronto, Ontario, Canada M5S 1H8
TEL (416) 946-7209
[email protected]
www.thecic.org
Name: (Mr / Ms / Mrs / Dr) ________________________________________________________________________________
Company: (if applicable)___________________________ Position: (if applicable) ___________________________________
Address: ______________________________________________________________________________________________
City:
__________________________________ Province: ____________________ Postal Code:___________________
Tel: (business) _______________________________ Fax: ________________________
Tel: (home or mobile) _________________________ E-mail: ____________________________________________________
Membership/Cotisation:
$75.00
$.........................................
$20.00
$.........................................
$45.00
$.........................................
$115.00
$.........................................
Digital Subscription (online access) / Accès numérique
Free/Gratis
 Please check to receive access
Member print subscription / Abonnement pour member
$38.00
incl HST
$.........................................
Student Member print subscription / Abonnement pour member étudiant
$29.00
incl HST
$.........................................
Regular Membership / Membre régulier
Student Membership / Membre étudiant
Young Professional Membership / Membre jeune professionnel
(under 35 years of age/35 ans ou moins)
Dual membership / Adhésion duelle (under same residential address)
Dual Member Name / Nom _______________________________
Dual Member Email______________________________________
International Journal Member Subscription (available in English only):
Journal prices include delivery to North American addresses only.
Les prix s’entendent pour une livraison à des particuliers ayant une adresse nord-américaine.
Donation to the CIC / Don à CIC
To National Office / Au secrétariat
$.................................
To Branch / a la section
$.................................
TOTAL
$___________________
Please indicate which electronic communications you would like to receive by checking the appropriate boxes:
 Weekly Dispatch
 Letter from the President
 Local Branch
 National Office Events
 Press Releases
Newsletter
Updates
Payment Options
 To sign up online please visit www.thecic.org. Or complete this form and return by mail.
 Cheque/Chèque (Please make your cheque payable to Canadian International Council. Veuillez libeller votre chèque à l’ordre du Conseil international du Canada et y
joindre cette copie.)
 Visa  MasterCard
Card No. / Compte No:__________________________________________
Expiry Date/Date d’expiration: ____________________ Name on Card/nom du détenteur:_________________________________
Signature: ____________________________________ CVV (three digits found on back of card):__________________________________
Membership is non-refundable and non-transferrable, and is exempt from HST except for the International Journal. Membership and donations are deductible for income tax purposes. A
receipt for income tax purposes will be issued to you. CRA Charitable Registration Number 10686 1610 RR0001. International Journal is published by SAGE Publications: HST Registration
Number 12978-6448 RT 0001. We value our relationship with you. We are committed to respecting and protecting the privacy and confidentiality of the personal information that you share
with us. By signing up for membership, you consent to receive electronic communications from the Canadian International Council, in compliance with Canada’s Anti-Spam Legislation. By
signing up for a free digital subscription to International Journal, you authorize transfer of your email address to SAGE Publications.
Les frais d'adhésion au CIC sont non remboursables, non transférables et exonérés de la TVH (sauf pour le International Journal). L'adhésion et les dons étant déductibles, un reçu aux fins de
l’impôt sera émis à votre nom. Numéro d’enregistrement d’organisme de bienfaisance à l’ARC : 10686 1610 RR0001. Le International Journal est publié par SAGE Publications. Numéro
d’inscription de TVH : 12978-6448 RT 0001. Soyez assuré que nous mettons tout en œuvre pour protéger votre vie privée et la confidentialité des renseignements personnels que vous nous
confiez.En vous inscrivant, vous consentez à recevoir des messages électroniques du Conseil international du Canada, conformément à la Loi canadienne anti-pourriel. En souscrivant
gratuitement un abonnement numérique au International Journal, vous autorisez le transfert de votre adresse courriel à SAGE Publications.