ALLLM 2018 Membership Registration

Association of Leaders in Lifelong Learning for
Ministry
Personal information collected from this form is done in compliance with privacy legislation including, but not limited to, the Personal Information Protection and Electronic Documents Act (2000, c. 5).

Please note that the fields marked with a red asterisk * are required.


Personal Information

Full Name*
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Email Address:*
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Day-time telephone number:*
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Address:*
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City, State/Province & Code*
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Membership Information

Which Institution do you come from?*
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What is your Role or Title?
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Affiliations with Other Organizations
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Which category of membership applies to you?*
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Payment

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You do not require a PayPal account to use this service. When you reach the Paypal website, simply click on the option "Pay with a credit card or VISA debit" and enter your information as a guest.

If you choose to pay with a personal cheque, we will send you the address in the email that confirms your registration.

Payment Option*
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Total Membership Fee
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Comments
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