SUSO

Contact Information
To apply for membership, complete this form and submit. Then print and mail to the address with a cheque or included credit card payment details. *Note: SUSO will only accept Visa. Your SUSO Membership will not be processed until payment is received.
Once your application has been processed, you will be sent further instructions to access our password protected Membership site.

(Last)

(First)

(M.I.)

Name:

Mailing Address:

Institution

Address:

City:

Postal Code:

Phone:

Fax:

Email Address:

Type of Membership:	1 Year		3 Years
Full Member:		$100.00		$250.00
Corresponding Member (outside of G.M.T.A.):		$50.00		$125.00
Resident:		$50.00
Enclosed is payment by:*		Cheque		Visa

Visa Number:

Expiry date:

Name on card:

Signature:

Share your contact information with other SUSO members? Yes No

If yes, please indicate which of your contact details we can add to the Member List:

Institution Phone number Email

Please print, fill out Credit Card details (if applicable) and fax or mail
to the SUSO office with your payment (*VISA or cheques only please):

3030 Lawrence Avenue East, Suite 510, Scarborough, Ontario M1P 2T7
Fax: 416-438-9590 Telephone: 416-438-9948

Please retain a copy of this notice as your receipt.