Platinum Level Membership Application Form - New or Renewal

Type of Membership Platinum Level - 1500.00 + GST

Registrant Information

Fields marked with * are required.
                                                 
Membership number (if known)
First name A value is required. *
Last name A value is required. *
Organization A value is required. *
Position/Title
Mailing Address A value is required.
City A value is required.
Province A value is required.
Postal Code Invalid format. Must be Uppercase, like:"X1X X2X", including the blank space.A value is required.
Telephone A value is required.Invalid format.
Fax
Email A value is required.Invalid format.
Training Coordinator
Training Email
Chair
Chair Email
Voting Representative Name
Please forward all correspondence attention to:
Please add my contact information as a FAJ member to a hard copy list
Please add my contact information as a FAJ member to the FAJ members only website

 

Payment Method

Invoice me (Platinum or Silver Membership only)
Please select payment method above.

Foundation of Administrative Justice
3438 - 78 Ave
Edmonton, AB T6B 2X9
Phone:780-466-0501
Fax: 780-466-8015

GST Exemption #
Subtotal