To become a CWC Member, please fill out the application below. Once we have your payment information, you'll receive your CWC username and password that will allow you to begin enjoying the benefits of your new CWC Membership, including access to the Membership Services area.

You will notice that there are several required fields(*) on this application form. These are the fields we must have to process your application. If you have only one set of contact information, please repeat the information in both the Company Information and Personal Information areas.

COMPANY INFORMATION:

Salutation:

*First name:

*Last Name:

Title:

*Company:

*Corporate Affiliation:

*Occupational Level:

*Region:

*Industry sector:

Salary Range:

*Phone:

Fax:

*Email:

*Company Address:

*City:

*Province/State:

*Postal Code:

PERSONAL INFORMATION:

*Home Address:

*City:

*Province/State:

*Postal Code:

*Phone:

Fax:

Email:

*Language:

Date of Birth:

Ethnicity:

Personal Website/Social Media sites:

*Number of Working Years in Communications and ICT Industry:

Please select board you are currently serving on:

Are you interested in serving on a Board:

MEMBERSHIP PREFERENCES:

*Please direct all correspondence to:

*For the membership directory please use:

*I wish to have my information show up in the member directory:

Referred By: (First name)

(Last Name)

METHOD OF PAYMENT: