Last Name: First Name: Title: Company: Address: City: Province: Postal Code: Telephone: Fax: Cell: Other Tel: Email: Website: Signature: Date: (MM-DD-YYYY) - - PLEASE COPY AND FILL OUT EACH CORPORATE MEMBER SEPARATELY PLEASE CHECK THE APPROPRIATE BOX GOLD LEVEL - $1,500.00 Plus $ 75.00 GST = $1,575.00 Unlimited Members - Your company will receive $1,600.00 Trafic Club User Card that can be spent on any event, luncheon or seminar within the current year. SILVER LEVEL - $750.00 Plus $ 37.50 GST = $787.50 Unlimited Members - Your company will receive $800.00 Trafic Club User Card that can be spent on any event, luncheon or seminar within the current year. BRONZE LEVEL - $200.00 Plus $ 10.00 GST = $210.00 TWO (2) Members - Your company will receive $150.00 Trafic Club User Card that can be spent on any event, luncheon or seminar within the current year. GST Registration 120006648
PLEASE NOTE: MEMBERSHIPS ARE NOT TRANSFERABLE