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Application Form

Please fill in the application form below. Dues can be paid annually, quarterly or by credit card on a monthly basis.

If you have chosen to pay your dues by credit card or if you would like to set up a monthly charge on your credit card to pay for your dues, BCPIA will contact you to obtain the required information.

GST will be added to the amount owing until June 30th, 2010. HST will be added on dues covering July 1st, 2010 onward.

Dues rates are based on annual sales. Do you need to check the rate categories? Membership Rates

Please fill and submit - we will contact you.
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-mail Address*
Web Site URL*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Business Phone*
Fax
Membership Category*
Active - Select Annual Dues Rate
Supplier - Select Annual Dues Rate
How do you wish to pay?*
What is your preferred payment option?*

Please enter the word that you see below.

  


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