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Alberta Association for Safety Partnerships
Registration

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Please fill out the following form and click "Send It".
If you prefer, the Alternate Printable Fax Form, may be used to register by Fax.

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Bold questions are required

Contact Information:

Company Name:
A value is required.
Contact Person:
A value is required.
Address:
A value is required.
Town/City:
A value is required.
Province:
Please select an item.
Postal Code:
A value is required.
Telephone:
A value is required.
Fax:
E-mail:
A value is required.

Industry Information:

WCB #:
Industry Code(s):
If your company has a C.O.R. include the # and expiry date:
C.O.R. #:
Expiry Date:
If your company has ever registered with another Certifying Partner please name:
If yes, you are required to let them know in writing that you are joining our Association.

Billing Information:

Membership Fees (choose one):
Small Employer (10 employees or less including owners) -   $325.00 + GST
Mid Employer (11 - 100 employees including owners) -   $450.00 + GST
Large Employer (over 101 employees including owners) -   $600.00 + GST
Please make a selection.Please choose only one employer category
Payment Method:
Please Invoice
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