Membership Form -

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- PDF File

Form below to be updated soon

Mr. checked --> > Mrs. checked> Ms. checked>

Name:

Lastname:

Work Address:

Home Address:

City:
Province:
Postal Code:

Country:

Work E-mail:

Home E-mail:

Work Telephone:	Home Telephone:	Mobile:

Work Fax :

Home Fax:

Preferred Language:

How do you prefer to be contacted:

Email: checked> Fax: checked> Mail: checked> Telephone: checked>

Professional Expertise:

Are you willing to be contacted to share your expertise?

Specify which parliament you represent and if you are from the upper or lower house (if applicable):

Terms/Years as Member of Parliament:

Parliamentary Committees Served in:

Previous anti-corruption involvement and experience:

GOPAC Secretariat

255 Albert Street, Suite 802
Ottawa, Ontario CANADA
K1P 6A9

Tel: (613) 237-0143 x. 319
Fax: (613) 235-8237