Membership form

* Username	* Password
* Legal name of the company	* Address
* City	* Province/State
* Country	* Postal code/ZIP
* Telephone ex.: 819 265-4774	Fax ex.: 819 265-4774
* Email	Website
* Member category	Add a logo (an additionnal cost of $ 50 for logo)
Logo
Description

* Mandatory field

Main contact

* First name :
* Name :
* Title :
* Telephone :	ex.: 819 265-4774
Fax :	ex.: 819 265-4774
* Email :
Note :

Contact #2

* First name :
* Name :
* Title :
* Telephone :	ex.: 819 265-4774
Fax :	ex.: 819 265-4774
Email :
Note :

Contact #3

* First name :
* Name :
* Title :
* Telephone :	ex.: 819 265-4774
Fax :	ex.: 819 265-4774
Email :
Note :

Contact #4

* First name :
* Name :
* Title :
* Telephone :	ex.: 819 265-4774
Fax :	ex.: 819 265-4774
Email :
Note :

Contact #5

* First name :
* Name :
* Title :
* Telephone :	ex.: 819 265-4774
Fax :	ex.: 819 265-4774
Email :
Note :

Please complete this form including all mandatory fields. Once your entry is accepted, an invoice reflecting you choice will appear on screen to be printed and will also be sent to your e-mail address. Please make your remittance to the Association des Compagnies de Téléphone du Québec inc. :

Without logo : 150.00$ annually plus taxes
With logo : 200.00$ annually plus taxes

You must pay your invoice within 30 days of receipt, in Canadian funds, to the address on your invoice.