Associate Group Membership Application

ASSOCIATE GROUP MEMBER APPLICATION
Organization Name*
As listed in the NS Registry of Joint Stock Companies
Nova Scotia Registry of Joint Stock Registration Number*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Primary Contact Person*

First NameLast Name
Primary Contact Position (ex. Chair, President, etc.)*
Primary Contact Phone Number*
Primary Contact E-mail*
Second Contact Person*

First NameLast Name
Second Contact Position (VP, Treasurer, Secretary, etc.)*
Second Contact Phone Number*
Second Contact E-mail*
Please provide an overview of your organization's mandate and a list of your organization's activities:*
Please provide any additional supporting documents.

JPG, PNG, PDF, doc, etc.
Cancelof
Will you be interested to participate in any of our member insurance programs? Please check all that apply. Note: This does not automatically enrol you in our insurance programs - we'd just like to get a sense of what you need!*

General Liability InsuranceGroup Accident InsuranceI need more information.No thanks, we've got it covered.
RISK MANAGEMENT ACKNOWLEDGEMENT *

NS Trails outlines some basic recommendations for our members in our Risk Management Policy. By signing below you acknowledge that you have read and accept the policy. To view the policy, click here.
Name*

First NameLast Name
Signature*

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Date

MonthDayYear
Date
Should be Empty:

ASSOCIATE GROUP MEMBER APPLICATION