Membership Form | MIAG Centre for Diverse Women & Families

MIAG Membership Application Form

* Please complete the following questionnaire.

Please check off the appropriate membership category*

Individual - Annual Fee $30

Non-Profit Organizations - Annual Fee $75

Corporates/Companies - Annual Fee $100

First Name*

Last Name*

Phone number*

Address*

City*

Postal Code*

Country*

Province*

Your email*

Free Text

Only for Groups, Organizations or Businesses:

Name of the Group/ Organization/ Business

Executive Director:

Contact Person:

Position

E-mail:

Address (If different than above)

City (If different than above):

Postal Code (If different than above):

Telephone

Website

Free Text

MIAG members are requested to read the attached Code of Conduct Policy and agree to follow it by signing

I read MIAG Code of Conduct Policy*

I read MIAG Code of Conduct Policy