Membership Application

Name *

Email Address *

Street Address *

Apartment, suite, etc

City/Town *

Province *

Postal Code *

Phone *

Membership Category

Membership Category *Individual (1 vote per individual) $50Organization 1 (a single vote, includes 2-9 members)* $150Organization 2 (a single vote, includes 10-20 members)* $250MPLAN Sponsor (see below description)** $400

Organizational Membership 1 & 2 - Additional Member Information:In the above box, please add your additional members' names and email addresses for Organization 1 (two to nine names) & Organization 2 (ten to twenty names) Membership Categories. (Or email your list to info@mbplar.ca.) Thank you!

**The MPLAN Sponsor receives the basic Organization 2 category plus placement of their corporate name and logo on MPLAN’s website and on all event promotional materials for their active membership year.

NOTE: The MPLAN Membership year is June 1 to May 31. You can join at any time during the year.

Payment

Payment *CHEQUE: Yes, I am sending a cheque payable to MPLAN in the amount selected above. (PO Box 181-971 Corydon Ave, Winnipeg, MB R3M 3S7)eTRANSFER: Yes, I am sending an eTransfer payment to mplan.board@gmail.comCREDIT CARD: Yes, I would like to arrange a phone call to process my credit card payment. I understand there is an extra 3.5% service fee added to my payment. I will email MPLAN to make arrangements.INVOICE: I will require a formal invoice from MPLAN in order to process payment with my organization.

NOTE: For clerical efficiency, please include with your payment a copy of your membership form or a note (detailing who/what the cheque is for OR an invoice number).

Receipt *YES, I will need a receipt once payment has been received and verified.NO, I will not require a receipt once payment has been received and verified.

Permissions

Mailing List *YES, I would like to be added to MPLAN's mailing list.NO, do not include me on MPLAN's mailing list.

Waiver *I give my permission for MPLAN (Manitoba Prior Learning Assessment Network) to use photos taken during the official events for website program files, media releases – newsletter, conference, educational and informational presentations. By checking this box you are acknowledging that you understand that you will be consulted about the use of the photo(s) for any purpose, other than those listed above and that there is no time-limit on the validity of this release nor is there any geographic specification of where these materials may be distributed.

Membership Application

Application form

Membership Category

Payment

Permissions