Online Membership Applications

*Required Field (CBN Membership year runs April 1 to March 31.)

Please select your membership type

Corporate (One Year Membership Fee: $1,500.00)
Individual (One Year Membership Fee: $325.00)
Public Sector (One Year Membership Fee: $250.00)
Student (One Year Membership Fee: $25.00)

Membership fees listed above do not include taxes.

First name: *
Last name: *
Title:
Telephone: *
Fax:
Email: *
School: *
Company: *
Address: *
Unit:
City: *
Country: *
Province: *
Postal Code: *
Electronic Correspondence: *	I agree to receive electronic correspondence I DO NOT wish to receive any electronic correspondence

Primary Company Member

First name: *
Last name: *
Title:
Telephone: *
Fax:
Email: *
Electronic Correspondence: *	I agree to receive electronic correspondence I DO NOT wish to receive any electronic correspondence

Additional Company Members

You may add a maximum of 9 additional company members.
You will have the ability to edit and add additional members after signup.
You may leave the first and last name field blank for any extra member rows you wish to be ignored.

Additional Member #1

First name: *
Last name: *
Title:
Telephone: *
Email: *
Address: *
Unit:
City: *
Country: *
Province: *
Postal Code: *
Electronic Correspondence	I agree to receive electronic correspondence I DO NOT wish to receive any electronic correspondence

Add Additional Company Member

Payment Information

Subtotal:	$0.00
Tax (GST/HST):	$0.00
Total:	$0.00
Name on Card: *
Card Number: *
CVC: *
Expiration (MM/YYYY): *	/