Membership ApplicationGST REGISTRATION #86481 2532 RT0001CAFA Membership v3 Date Date Format: MM slash DD slash YYYY Your Name* First Last Email* Cell PhoneLand Line Phone:FaxAddress Street Address Unit/Suite City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work InformationCompany NameJob TitleCredentialsCAFA ChapterWebsiteLinkedIn AccountPersonal InformationWhich Self-Regulating or Licensing Body you belong to?Want to be listed as a public speaker ?YesNoSpeaking Topics ( list 3+)CAFA Membership ApplicationUpload a picture of yourself and/or your firm's logo. Drop files here or Accepted file types: jpg, gif, png, pdf, tiff, jpeg.Brief Bio on Yourself & Description of services & expertise.Up to 5 Descriptors tags of area of specialty for web searchesie.Tax lawyer, Business consultant, conflict management, Dairy lender, poultry, etc.How long and what is your experience working with farm families or businesses?How did you learn about CAFA?Payment InformationProduct NameIf you live in Ontario, check Yes.*YesNoIf you live in PEI, check Yes.YesNoSelect your choice(s) - GST Regular Member: $385 (5% GST) Local Firm - up to 5 - $500 (5% GST) Provincial - up to 10 - $1500 (5% GST) Prorate Jan1-Mar 31 $190 + GST Prorate Apr1-June1 $80 + GSTIf you have any questions about LOCAL and PROVINCIAL Firm Membership, contact CAFA at 877-474-2871 or email@example.com.Select your choice(s) Ontario Regular Member Ont: $385 (13% HST) Local Firm Ont - up to 5 - $500 (13% HST) Provincial Ont - up to 10 - $1,500 (13% HST) Prorate Jan 1-Mar 31 $190 +HST Prorate Apr 1 - June 30 $80 + GSTIf you have any questions about LOCAL and PROVINCIAL Firm Membership, contact CAFA at 877-474-2871 or firstname.lastname@example.org.Select your choice(s) PEI Regular Member PEI: $385 (15% HST) Local Firm PEI - up to 5 - $500 (15% HST) Provincial PEI - up to 10 - $1,500 (15% HST) Prorate Jan 1-Mar 31 $190+HST Prorate Apr 1-June 30 $190 + GSTYou are able to select multiple choices. LOCAL FIRM: Unlimited staff memberships in ONE Chapter. PROVINCIAL FIRM: Unlimited staff memberships in any of the provincial chapters. If selecting this option, please provide the name and email of who will be responsible for remitting the payment on behalf of the firm members:Local or Provincial Contact NameLocal or Provincial Contact EmailPayment options I would rather send a cheque or phone in my card number Please send me an invoice Part of a firm membershipCAFA accepts Visa, MasterCard and American Express payments. Stripe is a PCI Service Provider Level 1 which is the highest grade of payment processing security. You can rest assured that your information is safe and secure.Mail Cheques to: CAFA PO BOX 270 Seven Sisters Falls, Manitoba R0E 1Y0 Or please contact the CAFA office directly at 1-877-474-2871 with your card number.Firm member names.Please list the names of who you are covering for CAFA membership.Instructions or Additional CommentsYour Total $ 0.00 CAD Credit CardAmerican ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.