Ontario Association for Impact Assessment  

87 Irondale Drive, 2nd Floor  
Toronto, Ontario M9L 2S6  
Att: Sue Ruggero  
E-mail: info@oaia.on.ca   Website: www.oaia.on.ca  

OAIA Membership
Name
First Name
Middle Initial
Last Name
Date    
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 ($40)  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)
Please Note: 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.