ICoTA Registration Form

ICoTA Annual Membership Form – for persons living in Canada
APPLICATION - 2008

Note: The Canadian Chapter of ICoTA collects the ICoTA membership fees for members living in Canada.

There are three types of memberships:

	$50.00 Individual Member Applicable to individuals with a declared technical or commercial interest in the coiled tubing industry. Eligible to participate on working committees and task groups.

	$35.00 Sponsoring Member Sponsoring Member: Same as “Individual Member”, except that the individual or the individual’s employer is a sponsor of the ICoTA – Canadian Chapter’s website, at www.icota-canada.com. (Website sponsorship is $200.00 CAD/yr)

	$25.00 Student Member Applicable to Students attending College, University, or Trade School. Part-time students that are employed in the industry are should apply for “Individual Membership”.

Please email icota@canada.com for any questions regarding this event or becoming an ICoTA member.

Your registration will be taken in two steps.

STEP 1: Select the membership type and fill out the form required below. Then press Submit. Your informaion will be sent to ICoTA staff and you will then be taken to PayPal.

STEP 2: Pay your registration fee using PayPal.

Both steps must be completed to complete your registration.*

I am a: a current member and renewing Membership number

NEW member

Name:

Company:

Job Title:

Business Interests:

(e.g., operator, tool rental, CT service, etc.)

Mailing Address:

City:

Province/Postal Code:

Phone Number:

Fax Number:

Email Address:

* Incomplete forms will not be accepted.