Ontario Association for Impact Assessment  

P.O. Box 2727, Postal Station D, Ottawa, Ontario, K1) 5W7  
E-mail: info@oaia.on.ca   Website: www.oaia.on.ca 
  

  Membership - 2004
  Name
First Name
Middle Initial
Last Name
  Position/Title
  Company Name
  Address line 1
  Address line 2
  City
  Province
  Postal Code
  Phone number  (Include area code)
  Fax  (Include area code)
  Email
  Member Status Current OAIA   Past OAIA   Current IAIA
  Member Type Regular ($30)  Student ($10)
  Tax Receipt Please send me a tax receipt
  Professional Expertise/Areas of Specialty/Interest
  Comments  (Items of information not to be listed in the on-line directory)
  The information provided will appear in the OAIA Directory of Members unless otherwise requested.

Verify above information and print the form. Please send a printed copy along with payment to the mailing address above.