QNET - Membership & Renewal Form

Membership & Renewal Form

New Member or Member Renewal?(Required)

Become a Member

Member Renewal

Organization

Organization Category(Required)

Other Organization Category(Required)

Organization Name(Required)

If not applicable, enter N/A

Address(Required)

Street Address City Province Postal Code

Website

Contact Person

Name(Required)

First Last

Position(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Membership

Membership Category(Required)

Representative(s) / Member List:

(Optional) Please provide the name, title, phone and email address for your confirmed member representatives in this text box, which can be resized via the bottom right corner:

Payment Options

Subtotal

$ 0.00 CAD

GST Exempt?

Yes (GST Registration #899755334RT))

GST

$ 0.00 CAD

Total

Payment Options(Required)

Purchase Order Number

If Required

Send the e-transfer to accounting@qnet.ca and include either your cell phone number or your reference number from the email that will be send to you after submitting this form.

Credit Card

American Express

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name