APPLICATION FOR STUDENT MEMBERSHIP

Address information First Name Last Name Address 1 Address 2 City Province Postal

Contact Information Location [?] E-Mail Address Telephone Cel phone Web site Profession Select Chapter

Membership Requirements Name of University, College, School Programme Name and Number Student Number Date of Graduation Scan of Valid Student Card included or, Scan of Registration and/or Transcript included or, Scan of Diploma (after Graduation) included Upload Scan I am of good moral character and agree to abide to the principles and ethics of CAPIC [http://www.capic.org/about.html?screen=coe]. LIMITATIONS
CAPIC Student Membership does not include access to insurance plans (health, dental, life or camera) nor does it include access to CAPIC Member Galleries.
CAPIC Student Membership is valid FOR ONE YEAR AFTER SIGN-UP. You will be automatically invoiced for your next Student year on the anniversary of your sign-up. I hereby apply for Student Membership to CAPIC and attest that all of the above and attached information is true. I agree to abide by the constitution and by-laws of CAPIC. I have also been made aware of and understand the limitations of my membership. Security Check

Upon clicking "Submit" you will automatically be taken to PayPal where you can pay using your PayPal account OR American Express, Mastercard or VISA.
Upon completion of the payment process you will receive an email confirmation and a PDF of your new membership card.

Privacy Policy CAPIC collects both personal and business contact information from its Members. The personal information is used to manage membership and related activities. Business contact information is made available on our website to drive business to Members. On occasion, personal and business contact information is the same. CAPIC will not release personal information without authorization except in those instances where personal contact information is identical to business contact information. By applying for membership in CAPIC, you acknowledge the above Terms & Conditions regarding release of your personal contact information. Personal or corporate financial information is destroyed after use (credit card information) or kept in a secure fashion. CAPIC does not release member information to sponsors or other third parties. Occasionally, CAPIC will forward information to you from our sponsors. You can opt out of this service by unsubscribing to CAPIC emails.

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APPLICATION FOR STUDENT MEMBERSHIP

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