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What area(s) will your Member Profile be placed?
Primary City/Area
($74.99/mo. + $160 "one-time" Profile Design Fee)
Additional City / Area (10% Discount)
Additional City / Area (15% Discount)
Additional City / Area (20% Discount)

Your Information: (as you'd like it to appear)
Your Name
Tag Line or Slogan
Your Website Address
Your E-mail Address

Company Information: (as you want it to appear)
Company Name
Address Line 1
Address Line 2
City
Province
Postal Code

Telephone Number Selection: (in the order that you want them to appear)
Phone Number 1
Phone Number 2
Phone Number 3
Phone Number 4

Social Media Profiles: (if applicable)
Social Media Address/Link
Social Media Address/Link
Social Media Address/Link
Social Media Address/Link
Social Media Address/Link
Social Media Address/Link

Bio or About Me/Us: (as you'd like it to appear)
If your bio is on an existing website, type the web address here and we will obtain it.
This field may also be left blank as we can add your "bio" at any point in the future.

Your Photo / Headshot:
You can attach your photo below, or we can obtain it from your existing website or Social Media Profile.
     I will attach it (below)
     Obtain from my website
     Obtain from my social media profile
     I will send at a later time

Attach Your Photo:

We will contact you by phone to obtain your payment information.
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Comments or Special Requests:

I have read and agree to the Member Agreement
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All funds in Canadian Dollars (Tax Not Included). Following the submission of this form, your membership will be official. We will create your Member Profile(s) based on the information submitted. We use this information to build your Member Profile, so be sure to proof-read prior to submitting. We will contact you by phone to obtain your payment information shortly.

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