CAJ MEMBERSHIP FORM

Please print and complete the form below, then mail to:

Canadian Association of Journalists
Algonquin College
1385 Woodroffe Avenue, B224
Ottawa, ON K2G 1V8
OR fax to: (613) 521-3904

Name : _____________________________________________________________

Home/Mailing Address (not to be published)

____________________________________________________________________
	
City : _____________________________________________________________

Province : _________________________________________________________

Postal Code : ______________________________________________________

Office phone : _____________________________________________________

Home phone : _______________________________________________________

Employer : _________________________________________________________

Work address (to be listed in the Canadian Directory of Journalists)

____________________________________________________________________

Job title : ________________________________________________________
	
Area of interest or beat : _________________________________________

Fax : ______________________________________________________________

E-mail : ___________________________________________________________


Membership (please choose one)

 __ One year                                   $75
 __ Two years                                 $140
 __ Income < $30,000                           $40
 __ Married/Co-habiting CAJ members            $60 each or
                                              $120 per couple
 __ Associate (non-journalist)                $150
 __ Student                                    $40

Caucuses (choose the ones you want)

 __ Aboriginal                              no charge
 __ Freelance                               no charge
 __ Journalism Educators                    no charge

TOTAL :                                      ________


We prefer cheques, but we also accept

__ VISA
__ Master Card

Name of Cardholder as it appears on card (please print):

___________________________________________________________________

Card # : __________________________________________________________

Expiry : _____ / ______

Signature : _______________________________________________________

Free Copy Of Sources :

__  If you haven't already received one, please indicate if you
    would like a free copy of Sources mailed to you.

Contact CAJ Office: (613) 526-8061  or  caj@igs.net