CCM - Online Registration

Membership Renewal Form - 2011

As per the agreement made between the CCM and the AMQ Board of Directors members of the CCM (RM, SCCM, and FCCM but not Associate members) will have the OPTION to join the Association des Microbiologistes du Quebec for an additional fee of C$25.00 (twenty five).

Renewal Type

Member Type

Title

First Name with Initial

Surname

Business Address including Postal/Zip Code

Business Telephone

Business Fax

Business E-mail

Residential Address including Postal/Zip Code

Residential Telephone

Residential Fax

Residential E-mail

Which address would you prefer for CCM correspondence?
Business Residential

Thank you very much for completing our online renewal form.

Payment may be made using either PayPal (use the link below), by cheque or money order (see the CCM mailing address below).

Please print the completed form and send it with your cheque or money order to:

Nous vous remercions de compléter ce formulaire, de l’imprimer et de l’envoyer avec votre cheque, traite bancaire ou mandat cheque, à l’adresse suivante :

Canadian College of Microbiologists/Collège Canadien des Microbiologistes
356 -1568 Merivale Road
Ottawa, Ontario
Canada K2G 5Y7

A RECEIPT WILL BE SENT BY E-MAIL OR HARD COPY
UN REÇU VOUS SERA ENVOYÉ PAR COURRIEL OU PAR LA POSTE