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Registration form for the regulat members

Complete the form below then validate. When you will have validated your form, your request of membership will be submitted in to the approval of the C.A. of the ADICQ. You will receive then your invoice by e-mail. Pay nothing as long as you did not receive your invoice !
Current price lists :
- Less than 10 employees : 300.00 $ + taxes if applicable
- More than 10 employees : 650.00 $ + taxes if applicable
- Individual member : 100.00 $ + taxes if applicable
 


                     
Company* :
First / Last name* : /
E-Mail* :
 
 
Address 1* / 2 : /
City* / Zip code* : /
Country* / State : /
 
 
Phone 1* / 2 : /
Cell / Fax : /
 
Corporate profile
Category* / Type* : /
Nbr employees* : (total) /  (in Quebec)
Were you already a member ? No Yes / Year of creation :
Web site : http:// 
 
Offered services
Brief description
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Detailed description
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Have you expectations, needs or particular concerns to ask us ?
Your expectations
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How did you hear about the ADICQ ?
Comment
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Compose the descriptive text of your products and services for the directory
Description directory
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