Membership Application - Non-Practicing Full / Retired

Contact Info

Prefix

First Name *

Last Name *

Email (Personal) *

Organization/Employer *

Phone *

Phone (Cell)

Fax

Preferred Language *

Secondary Email (Work) *

If you don't have a second email, enter the same email address twice.

Do you currently hold a membership with your Provincial and Territorial Institute or Association (PTIA), L'Ordre des urbanistes du Québec (OUQ)? *

What is your current membership type with L'Ordre des urbanistes du Québec (OUQ)? *

Street Address *

City *

Province / Territory *

Country *

Postal Code *

Street Address

City

Province / Territory

Country

Postal Code

Address to be listed on invoice *

Preferred address to receive mail *

Would you like to appear in the public directory? *

Opt out of third party mail? *

How did you hear about us?

I certify that the information I have provided on this form is correct, and that I am eligible for the membership category for which I am applying *

I certify that I understand that subscription and membership fees (if applicable) are non-refundable *