Membership – Professional

Application & Payment

 

Contact Information
** = Required

**First Name: **Last Name:
**Email Address: Telephone Number:
Address: City:
Province: Postal Code:
 
Membership Category (Required):
New application or renewal?:
 
About You
If you are currently working, what is your Job Title?
If you are currently working, what is the name of your Company?
What is your area of work or study/major?
 
Declarations (Required)
For each item below, select "Yes" if you agree, "No" if you disagree.
     
    I understand and support the objectives of WISE NL.
    YesNo

    In accordance with the Canadian Ant-Spam Legislation (CASL), I grant permission to include my email address in the WISE NL email distribution list.
    YesNo

    I understand that WISE NL collects this information for the internal use of WISE NL only and will not share this information with third parties without expressed permission.
    YesNo
 
Submit Application

  • By submitting this form, you're granting: WISE NL, PO Box 23176, Churchill Square, St. John's, NL A1B 4J9, Canada http://www.wisenl.ca permission to email you. You can revoke permission to mail to your email address at any time using the SafeUnsubscribeTM, found at the bottom of every email.
  • Emails are serviced by Mailchimp. Mailchimp takes your privacy seriously. To see for yourself, please read the Mailchimp Email Privacy Policy.
  •  

  • Online payment for professional membership, which includes a transaction fee, is $26.75.
  • After submitting this form you will be redirected to PayPal. No PayPal account is required.
  •  

  • If you wish to pay by cash or cheque, which does not incur a transaction fee, do not used this form. Please submit a paper application.
  •