Partners in Protection - Registration Form

Online Membership Application, Renewal, Event Registrations and Donations are under Review. For Membership Application, please complete the Membership Form and forward by mail, Email or fax.

Please make cheque or money order to: Partners in Protection Association.

Membership Type (select one)

Corporate Membership ($250)

Agency
Organization/Association
Business/Industry
Research/Education

Individual Membership ($50)
Honorary Membership (No charge)

Membership Information

Corporate Name
First Name
Middle Name
Last Name
Home Phone
Business Phone
Fax
E-mail
Address

City
Province	Other:
Postal Code
Comments

Payment

You may pay using cheque, money order, or credit card. We do not accept credit cards over the internet at this time. We will contact you within 10 business days to arrange payment. It is very important, therefore, that your contact information entered above is correct. If we can not reach you, your membership application will not be processed.