Membership & Donations

First Name:
Last Name:
Organization:
Address:
City:
Province:
Postal Code:
Telephone:
Fax:
E-mail:


Our basic annual membership fee


Individuals - $25
Family - $45
Health Professionals - $100
Retailers and Organizations - $200
Manufacturers and Distributors - $500

Total $:

Please invoice me directly:
or charge my credit card:

Card #:

Expiry:

Enter the words below: