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| * Last Name | |||
| * E-mail Address (note: each member must have a unique e-mail address) | |||
| * Membership Type | |||
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Individual Membership (Can$75 per annum) Student Membership (Can$25 per annum) |
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| Organization/University | |||
| * Address | |||
| * City | |||
| * Province | |||
| * Country | |||
| * Postal Code | |||
| * Phone | |||
| Fax | |||
| Students/Postdoctoral Fellows State Program | |||
| Supervisor (if applicable) | |||
| Web Site Address | |||
| My area(s) of professional/research interest(s) is/are | |||
* required fields
