Membership form

Information about the organization

Name of organization

Address

City

Postal Code

Phone Number

Name of the contact person

Email of contact person

Phone number of contact person

Person responsible for billing and payments

Name of the contact person

Email of contact person

Phone number of contact person

Types of membership*Annual cost of membership

Regular member and licensee of Health Canada - 15 000$

Regular member and Health Canada license applicant - 7 500$

Microcultivating member - 2 000$

Associate member - 5 000$

Partner member - 0$

Payment method

Per month

Twice a year

Four annual payments

Payment in full

Please send your payment by Interact transfer to
Caisse Desjardins STE-AGATHE-DES-MONTS
77, RUE PRINCIPALE E
SAINTE-AGATHE-DES-MONTS, QC

Institution number : 815
Account number : 8419
Identification number : 30190