CSIH Membership Application

Thank you for considering to become a member of CSIH. Membership benefits include reduced rates to the Canadian Conference on Global Health, our online newsletter "Synergy", the opportunity to participate in our Advocacy Committee, our Board of Directors and various Global Health events across Canada

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CSIH Membership * Required

	Regular - 1 Year
CSIH Regular Membership	$ 50.00
Student/Non-Wage Earner	$ 25.00
Organizational	$ 250.00

Taxes are extra as applicable.

Promo Code

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Personal Information

First Name * Required Last Name * Required Organization * Required Job Title Industry * Required

Address Information

Address 1 Address 2 City Country Province/State * Required

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Contact Information

Telephone (Use only: [0-9 and -]) Ext Toll-Free Toll-Free Ext Fax (Use only: [0-9 and -]) Cell

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CSIH membership emails * Required

I agree to receive CSIH emails, and understand that I can unsubscribe at any time.

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Professional Information

What is your Profession?

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Security Captcha * Required

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How many provinces and territories are there in Canada?