CIP Membership Form (OUQ)

Do you currently hold a membership with your Provincial and Territorial Institute or Association (PTIA), L'Ordre des urbanistes du Québec?:

YesNo

What type of CIP membership are you applying for?:

Have you previously held a CIP Membership?:

YesNo

What date did you become a Provisional/Candidate member of your PTIA?:

What date did you become a Full Professional member of your PTIA? (If applicable):

CIP Clauses:

I certify that I am a member in good standing of my PTIA:

YesNo

I certify that CIP can send me email as required. Review the CIP privacy policy (see link above):

YesNo

I certify that the information I have provided on this form is correct, and that I am eligible for the membership category for which I am applying:

YesNo

Organization/Employer:

Please provide the following details:

Title:

First name:

Middle Name:

Last name:

Physical Address (where you are currently living):

City/Town:

Province/Territory:

Postal Code (ex. L1A 4M5):

Email:

This will be your login email address. Confirm email:

Birthdate:

Gender:

MaleFemaleNon binary

Telephone:

Alternate Phone (Cell/Work):

Preferred Language:

Would you like to purchase individual professional liability insurance through CIP provided by BMS? The annual cost is $44 plus taxes:

YesNo

Payment Preference (please address cheques to Canadian Institute of Planners):

If you would like to pay by credit card, please provide the full name of cardholder:

Credit card number:

Expiry date:

CVC number (3 digit number beside the signature):

Display in Find a Member?:

YesNo

Opt out of Third Party Mail?:

YesNo

Shaping our Communities
Sustaining Canada's Future.

CIP Membership Form (OUQ)

Reference Documents

Address:	Adresse :	141 Laurier Avenue West, Suite 1112, Ottawa, ON K1P 5J3	141, avenue Laurier ouest, Bureau 1112, Ottawa (Ontario) K1P 5J3
Telephone number:	Tél :	800.207.2138 or 613.237.7526 (PLAN)	800.207.2138 ou 613.237.7526 (PLAN)

Shaping our CommunitiesSustaining Canada's Future.

CIP Membership Form (OUQ)

Reference Documents

Shaping our Communities
Sustaining Canada's Future.