Applicant (Individual /Corporate)

Title: Dr. Mr. Mrs. Ms.

Nature of Business

Degree(s) (or pursuing degree)

Position

No. of Employees

Employer Name /Owner Name

Business Phone

Business Fax

Home Phone

Home Fax

Mailing Address

E-mail

Web Site

Name of Representative

Position

Tel (Business)/(Residence)

Annual Membership Fees

Group Members $100 Regular members $20 Student members $10

Or I would like to donate $ _________ towards Association as nominal membership fees.

Please make the cheque payable to: CCAFIP, 2505 Poplar Crescent, Mississauga, ON L5J 4H2

• Membership fees subject to annual review
• Discount rate is available upon request. Please contact CCAFIP officers at CCAFIP@yahoo.ca or call 905-823-5263.

Signature of Applicant

Date

What would you like CCAFIP to provide professional services for you?

What would you like the Newsletter (FOOD PULSE) to cover more?

In what area, you think you can contribute to the association and the Newsletter?

Other General Suggestions.

MEMBERSHIP CARD No.:

DUE DATE:

REMARKS: