Name:
Title:
Employer:
Address:
Suite:		City:
Province:		Postal Code:
Telephone:		Fax:
E-Mail:
Language Preference:	English     French
How did you hear about ACSESS?
What is your primary reason for joining ACSESS?
Do you hold a CPC designation?	Yes     No
Do you wish to pursue the CPC program?	Yes     No     N/A
DUES PAYMENT
Membership year is January 1 to December 31. Dues are subject to 13% HST (#871631198) and must be submitted with the application. Candidate Member: $150 Individual Member: $250 How would you like to pay? Cheque (please make cheque payable to ACSESS) VISA     MasterCard     AMEX
Authorization The undersigned hereby applies for membership in the Association of Canadian Search, Employment & Staffing Services (ACSESS). I, on behalf of my company, hereby pledge to adhere to the Code of Ethics & Standards of ACSESS in the best interests of the industry and the public that it serves.
Authorized signature:
Date:	7/31/2010 8:12:42 AM