LMDA Canada - Membership

To receive a membership with LMDA Canada complete the form below, print and mail with a cheque or money order to LMDA Canada (mailing address below). Upon receipt of your payment you will receive a member registration number.

$Cost/Year	$500.00
GST	25.00
Total	$525.00

GST Number: 85594 2645

Please note that red fields are required

First Name
Last Name
Title
Company
Address
Address 2
City
Province
Postal Code
Country
Phone	Ext.
Fax
Cell Phone
E-Mail

Print and Mail this form with your cheque or money order (LMDA-Canada) to:

LMDA Canada

The Exchange Tower, Suite 1600
P.O. Box 480, 130 King Street West
Toronto, Ontario, Canada M5X 1J5