AUTOMATIC MEMBERSHIP REGISTRATION

AUTOMATIC MEMBERSHIP REGISTRATION
Company's Legal Name (as registered with WCB): *
Operating Name:
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Email: *
WCB Account Number: *
WCB Industry Code: *
Affiliated Companies (if applicable)
Legal Name(s):
WCB Account Number(s):
WCB Industry Code(s):
Indicate if you are a member of:

The Manitoba Home Builders’ Association The Winnipeg Construction Association
Name: *
Title: *
Signature: *

Clear
Date: *

Month Day Year
My signature indicates that all the above information is current and accurate.
The information provided will be used for automatic membership registration. This information will need to be disclosed to the provincial government to actually award the COR^TM/SECOR^TM certification. Upon receiving COR^TM/SECOR^TM certification the company information will be posted to the Construction Safety Association of Manitoba’s website, www.constructionsafety.ca. Except as described herein, we do not sell, rent or otherwise share or disclose your private personally identifiable information to third parties.
ALL APPLICATIONS WILL BE SUBJECT TO A QUALIFYING REVIEW AND APPROVAL PROCESS
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