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To become a Canada Safety Council member print out this form, and mail or fax it to the Canada Safety Council along with a check or credit card information.

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YES! I/we support the work of the Canada Safety Council.

How did you learn about CSC?

What attracted you to membership?

Membership:

Name:

Title:

Organization:

Address:

City: Province:

Postal Code: Telephone: Fax:

E-mail:

Payment
Cheque enclosed

OR Credit card: Visa MasterCard American Express

N^o: Expiry:

Name: Signature : _______________________

OR Please send invoice ($250 minimum) PO #

Thank you
Return this form with your contribution to:
Canada Safety Council, 1020 Thomas Spratt Place, Ottawa, Ontario K1G 5L5
Telephone: (613) 739 1535. Fax: (613) 739 1566

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YES! I/we support the work of the Canada Safety Council.

Payment Cheque enclosed

Payment
Cheque enclosed