Membership Application

Date:		Name:
Title:		Paper:
Company:		Address:
City:		Province:
Postal Code:		Phone #:
Fax #:		Email:
Spouse:
Number of years as circulator:
Number of years in present position:

1st Annual due payable: $125.00
Make cheque payable to :
Canadian Circulation Management Association
Membership applications will be processed upon receipt of payment.
Return application and initial cheque
by mail to: D. Dorman
CCMA Secretary Treasurer
100 Belliveau Beach Rd.
Pointe-du-Chene, N.B.
E4P 3W6