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Associate Membership Form

Please complete the following form and send a copy to us by hitting submit at the bottom

Your Name
Address
City
Province	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code
Telephone
Fax
E-mail
Website
Type of service you offer
Your interest in / connection with Christian publishing
Affirming the constitution, code of ethics and the information provided above,
E-mail signature and title
Date

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