At this time UCPBA Ottawa is unable to process membership requests by internet. Completed membership application forms may be sent with appropriate fees to:
   UCPBA Ottawa, Attn: Membership,   913 Carling Ave.,Ottawa, ON K1Y 4E3

Membership Category: Single ($55)____ Family ($65)____ Student ($10)_____

Member 1 Name: _______________________________________________________

Occupation / Title:  ______________________________________________________

Employer: _____________________________________________________________

Work phone: (______)___________________ Work fax:(________)_______________

E-mail: _______________________________________________________________

Member 2 Name: _______________________________________________________

Occupation / Title: ______________________________________________________

Employer: _____________   Work phone: (___)______   Work fax:(______)_________

   E-mail:______________________________________________________________

Home Address:_________________________________________________________

Home phone:(____)________________ Home fax:(_____) ______________________

Web site: ______________________________________________________________

Publish home phone number?             YES _________ NO _________

Electronic version of newsletter?         YES _________ NO _________

Link web site to UCPBA Ottawa site?  YES _________ NO _________

Payment Enclosed _________             Amount __________