Organization Membership Application 2012-2013

To submit a membership application for your organization, please complete and submit this form. Please note that you must fill out fields that are marked with an asterix (*).

Website Account Information

Once your membership is finalized, you'll use this information to log into the YHMA website.

Username *

Password *

Confirm Password *

Organization Information

Organization Name *

Address *

City *

Province or Territory *

Postal Code *

Country *

Phone Number *

Cell Phone Number

Fax Number

Email Address *

Web Address

Membership Level

Please select the level of membership for which you are applying.

Business: $131.25
Contributing Memberships - Level 1 (under $50,000): $36.75
Contributing Memberships - Level 2 ($50,000 to $150,000): $52.50
Contributing Memberships - Level 3 ($150,000 to $300,000): $68.25
Contributing Memberships - Level 4 ($300,000+): $84.00

Business Listing

Please provide up to 40 words that describe your organization, to appear on our website.

Payment Method

Please select the method you will be using to pay for your membership. We cannot accept payment online. Instructions for sending your payment to us will be included in an email you'll receive after you submit this form.

Cheque
Cash
Credit Card
PO#

Communication Method

Please indicate how you would like to receive the YHMA newsletter, information about our AGM, special event notifications, membership renewal notifications, and other updates from us.

Email
Post

Human Verification

By verifiying the characters in the box below, you will help us reduce fraudulent, machine-submitted membership applications.