CAPIC Application Form

Membership Application

Please complete the form below to apply to become a CAPIC member.
Membership type*
Chapter*
Learn more about our Membership categories.
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
Profession*

PhotographerIllustratorOther
Website URL
Instagram URL
Facebook URL
Linkedin URL
Student School*
Graduation Date*

MonthDayYear
Date
Profile Image.

Will be used on our Members directory page.
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How did you hear about us
Preferred language

EnglishFrench
Conditions:
- I am an active professional photographer or illustrator with at least two (2) years of professional experience.
- Self-employed applicants must attach blank samples of their business forms, (e.g., Quote, Invoice, Terms & Conditions, and Other Contracts). Employed applicants are required to list employer's name and place of business.
- I should provide a Web address in order to access my portfolio
- I will complete a Member Survey form upon acceptance.
- I am of good moral character and agree to abide to the principles and ethics of CAPIC.
Upload required documents: quote, invoice, or Student Card*

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Agreement - Membership*

I hereby apply for a membership in CAPIC and attest that all of the above and attached information is true. I agree that any misstatement or misrepresentation will void this application.
Do you consent to receive email communications from us regarding membership, association/industry news, PD Opportunities and partnering organizations?*

YesNo
Should be Empty:

Membership Application