Members
Member [Registration]
* Mandatory fields
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First Name:
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Last Name:
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Email Address:
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Password
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Re-enter Password
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Member Type:
General Member
Student Member
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Mailing Address:
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City:
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Country:
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Australia
Barbados
Belize
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Cameroon
Canada
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Israel
Japan
Jordan
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Lebanon
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Philippines
Romania
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senegal
Singapore
South Africa
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Turkey
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UK
Ukraine
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Other
Country - Other:
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Province:
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Province - Other:
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Postal Code:
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Day Time Phone Number:
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Extension:
Alternate Phone Number:
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Business Name for Directory:
Employer:
Title:
I am interested in information about CACPT
I wish to be listed in the CACPT Membership Directory
NOTE: If you are a new Member, were you referred by a current Member?
Select
Yes
No
Name of Member: