P.M.C.Q. Membership Application Form 2009 / 2010
Season: September 1, 2009 - June 30, 2010

Name

Title

Company

Address

City

Postal Code

Province

Tel.

Fax

E-mail


If you would prefer to receive meeting notices at a different address, please indicate address below:


Address

City

Postal Code

Province


Occasionally the PMCQ mailing list is made available to organizations for subjects of interest to our members. If you do not wish to receive such information, check here.


Please indicate your industry classification:


Pharma Company

BioTech

Advertising Agency

Media

CHE / CME

Other


What are your suggestions for the speakers agenda?



Invoicing 2008 / 2009 PMCQ Membership

Return with payment to:

  • CMPQ/PMCQ
  • CP/PO Box 813, 15 avenue Donegani
  • Pointe-Claire-Dorval (Québec) H9R 4Z5
  • Tél : (514) 486-3458
  • Fax : (514) 486-4794

Annual Regular Membership (per person)

$282.19 = $250.00 + taxes [5% GST ($12.50) + 7.5% QST ($19.69)]


Annual Privileged Membership
(per person, including membership and monthly dinner fees)

$564.38 = $500.00 + taxes [5% GST ($25.00) + 7.5% QST ($39.38)]


Payment by:

Cheque

Visa

Mastercard

American Express


Card #:


Expiry Date:

Cardholder's Name:

Signature: