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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:
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:
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)]
G.S.T.: 101019735 Q.S.T.: 1002033794
Payment by:
Cheque
Visa
Mastercard
American Express
Card #:
Expiry Date:
Cardholder's Name:
Signature: