Community Member Registration

what best describes you? *

I am a student

I am faculty

Branch *

Salutation *

First Name *

Last Name *

Date of Birth

Primary Phone Number *

Secondary Phone

Primary Email*

Secondary Email

Position

When will you graduate? (Student member only)

Home Address

Address 1 *

Address line 2

City *

Province *

Postal Code *

Country *

School Address

Name of School *

Existing Office

Website *

Telephone

Fax

Address Line 1 *

Address Line 2

City *

Province *

Postal Code *

Country *

Professor

Salutation

First Name *

Last Name *

Primary Email*

Address 1

Address line 2

City

Province

Postal Code

Country

PLEASE SEND CORRESPONDENCE TO MY *

school

home

Upload faculty advisor verification *

Maximum size 20 MB

Professor consents to the information being provided on this application. *

Confirm

Do you consent to have your information displayed in the CMAC online directory? *

CMAC produces a real-time directory for members. You may customize your communication preferences at any time by accessing your profile.

Yes, display my name and contact information.

Yes, display my name only.

No, do not display my information.

Were you previously a member of CSCM? If so, which year(s)?

Password must be a minimum of 8 characters long and contain at least 1 uppercase letter, 1 lowercase letter and 1 number.

Password

Confirm password

By submitting this registration form, I agree to abide by CMAC’s Code of Ethics and to refrain from using the CMAC member roster for marketing or advertising purposes of any kind.