http://citt.org/_Library/forms/CITT-ICTSmembershipform2009

Page 1

MEMBERSHIP APPLICATION FORM INDIVIDUAL

CORPORATION

STUDENT

$35

ORGANISATION Not for profit

$195

Includes 1 Profile ID # School:

$95

$170

Includes 2 Profiles

INDIVIDUAL

$425

PROFESSIONAL

$925

Includes 1 Profile The basic personal membership

Includes 1 Profile Higher level of individual support

SUSTAINING

Includes 4 Profiles The basic corporate membership

CONTRIBUTING

Includes 6 Profiles Higher level of corporate support

CONTACT INFORMATION Name of Member:

(Individual or Corporation)

Name of Contact Person or Name of Company/ Organization (if applicable) Street: City: Province:

Postal Code:

Phone:

Fax:

2e Phone:

Web:

Email:

CAUCUS AFFILIATION EACH CITT/ICTS MEMBER IS ENCOURAGED TO JOIN ONE OR MANY CAUCUSES, ACCORDING TO THEIR PROFESSIONAL INTERESTS, AND TO ACTIVELY PARTICIPATE IN THESE. CAUCUSES HELP DETERMINE PROGRAMMING, PARTICIPATE IN OISTAT SPONSORED INTERNATIONAL PROJECTS AND ARE ACTIVE IN STANDARDS REVIEW AND ADVOCACY. PLEASE SELECT ALL AREAS PERTINENT AND OF INTEREST TO YOU.

Architecture Education Management Sound

Automation Imagery (projections, etc,) On Deck Video

Design Lighting Props Wardrobe

PAYMENT I AM PAYING BY Card number

VISA

MASTERCARD

CHEQUE (payable to CITT/ICTS) Expiry

Name on Card Signature

Date

Mail this form to CITT/ICTS National Office, 340-207 Bank St. Ottawa, ON K2P 2N2 or fax to (613) 482-1212 Questions (613)482-1165 or 1-888-271-3383 or info@citt.org


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