Membership & Renewal Form New Member or Member Renewal?(Required) Become a Member Member Renewal OrganizationOrganization Category(Required)Consulting/Training ServicesEducational InstituteGovernmentHealth CareManufacturingNon-profitServiceOtherOther Organization Category(Required) Organization Name(Required) If not applicable, enter N/AAddress(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Website Contact PersonName(Required) First Last Position(Required) Phone(Required)Email(Required) Enter Email Confirm Email MembershipMembership Category(Required)Personal - 1 Representative ($145.00 + GST)Corporate I - 2 Representatives ($225.00 + GST)Corporate II - 5 Representatives ($455.00 + GST)Corporate III - 10 Representatives ($675.00 + GST)Charter ($2,000.00 + GST)Representative(s)*You have the option to add your representatives here. Row ID Representative Info Name Title Phone Email Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Payment OptionsSubtotal $ 0.00 CAD GST Exempt? Yes (GST Registration #899755334RT)) GST $ 0.00 CAD Total Payment Options(Required)Invoice Contact Persone-TransferCredit CardPurchase Order NumberIf 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 ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code on card back CAPTCHA
