Membership Application

APPLICANT INFORMATION

We Hereby apply for membership in the Canadian Automatic Merchandising Association, and if approved, we agree to abide by the Association's Constitution and By-Laws

Company *
Website
Address *
City *
Province/State *
Postal/Zip Code *
Phone *
Fax
Email *

Official Representative

Please provide contact information of an official representative who will receive mailings and vote on behalf of your company.

First Name *
Last Name *
Title *
Phone *

Secondary Contact (optional):

First Name
Last Name
Title
Phone
Email

BRIEF COMPANY PROFILE/DESCRIPTION OF SERVICES *

MEMBERSHIP DUES

Operator	(based on fee schedule)
Regional (Operates from one fixed address in a single province. Operator may have additional distribution warehouses within the same province.)	$325
Provincial (Operates 2 or more dedicated locations in the same province.)	$525
National (Operates multiple branches across multiple provinces.)	$1025
Supplier	(based on fee schedule)
Provincial (Suppliers of products and/or services across vending, OCS or MicroMarket industries within a single province.)	$650
National (Suppliers of products and/or services across vending, OCS or MicroMarket industries within Canada.)	$1050
International (Suppliers of products and/or services across vending, OCS or MicroMarket industries throughout North America or globally.)	$1300

(plus applicable taxes)

Subtotal	$0.00
Tax	$0.00
Total	$0.00

CERTIFICATION OF DUES

I certify the above information is complete and correct.

Name on Card: *
Card Number: *
CVC: *
Expiration (MM/YYYY): *	/

All information provided regarding dues calculations is kept in the strictest confidence.