CORPORATE MEMBERSHIP APPLICATION/RENEWAL

CORPORATE MEMBERSHIP JULY 1, 2010 - MARCH 31, 2011 (nine months only)

For additional information please contact:
Stephen Laramee
c/o RTSO
4505 Paddock Trail Drive
Niagara Falls, Ontario
L2H 3E6

CORPORATE MEMBERSHIP APPLICATION

Company Name:

Address:

City:

Province:

Postal Code:

Telephone:

Fax:

Designated Representative:

Position/Title:

CORPORATE MEMBERSHIP FEE:

Nine Months Corporate Membership $169.50 CDN ($150.00 + 19.50 HST)

PAYMENT by CHEQUE:

Cheque

HST Registration #107889339
Make cheques payable to: Respiratory Therapy Society of Ontario Send to: Respiratory Therapy Society of Ontario, P.O. Box 30007, RPO Montrose, Niagara Falls, ON L2H 0C1

PAYMENT with VISA/MASTERCARD:

VISA or MasterCard

If paying by VISA/MasterCard, please provide the following information:

Cardholder's Name:

Visa/MasterCard No.:

Expiry Date:

RTSO Privacy Notice

The process of collecting and using information about individuals is now more complicated as a result of legislation, the Personal Information Protection and Electronic Documents Act (PIPEDA). PIPEDA applies to personal information. It is information about an identifiable individual, but does not include the name, title, and business address or business phone number of an employee of an organization. It does not apply to information about corporations, PIPEDA applies only to individuals. Any personal information collected by RTSO is used solely for the purposes of providing membership services and will not be used for any other purpose without your consent.

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