New Membership Application V5.0

Membership Application

Canadian Association of Medical Device Reprocessing
Section One - Personal Information

Please complete all sections.
First Name: *
Last Name: *
Street Address: *
Apt.:
Province/State: *
City/Town: *
Postal Code/Zip: *
Country: *
Phone: *
Email: *
Section Two - Facility Information
Facility Name:
Facility Address:
Suite/Floor:
City/Town:
Province/State:
Postal Code/Zip:
Country:
Current Position:

Technician Lead/Supervisor Manager Other (Please fill in the box below)
"Current Position - Other"
Other Designation:
Work Phone (With Extension)
Section Three - Membership Type

Membership period begins the date of application approval. Memberships purchased before September 1 will expire on December 31 of the year of purchase. Memberships purchased on or after September 1 will extend to December 31 of the following year.
Province of Residence *
Membership Type: *
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Active Membership $ 50.00 CAD

Associate Membership $ 50.00 CAD

Two Year Membership $ 80.00 CAD

Subtotal $ 0.00 CAD Tax $ 0.00 CAD Total $ 0.00 CAD
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Did a CAMDR member refer you to this association? *

Yes No
If you answered "yes" to above, please add the name of the CAMDR member:
Click 'Submit' to complete your membership registration. This will bring you to PayPal to complete our payment process.
Should be Empty:

Membership Application