Request for Membership Application Package

Please complete the following form to receive a membership application package.

Name:
Title:
Web Address:
Organization/Company:
Address:
City:
Province/State:
Postal/Zip Code:
Phone:
Fax:
Email:
Member Type:	[PLEASE SELECT] Charitable Home Municipal Home Non-Profit Nursing Home Non-Profit Community Service Agency Non-Profit Seniors Housing Chronic Care Hospital Developing Organization - Facility Developing Organization - Housing Commercial Supplier - 4+ employees Commercial Supplier - less than 4 employees Associate Member Education Facility Personal Member

You must complete the following question to submit your application:
What is the sum of 12 + 36?

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