On - Line

Membership Application Form

RECORDS MANAGEMENT INSTITUTE

Date: yyyy-mm-dd

Name:

Title:

Organisation:

Direction/Division

Mailing Address: (City, Street, Postal Code)

Telephone: 111-222-3333

Fax: 111-222-3333

E-mail Address :

Individual: 35,00$            Corporate:  200,00$

Make Cheque payable to the Records Management Institute and mail to: Records Management Institute

                                                                                                                      Box 2856,

             Succ. D, Ottawa ON K1P 5W8

Credit Card Payment Not Accepted

Note:  One Corporate Membership allows up to eight Representatives

Receipt Required:

Type of Membership:

Additional Names: (Append a list, include Name, title, organization, Department, address, telephone, Fax and e-mail information :

Individual

Corporate

Yes

No