Registration

Name:
Company:

Mailing Address(es):

(Canada)

Number and Street:
City:
Province:	British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland Northwest Territories Yukon Nunavut
Postal Code:

(Ukraine)

Oblast':	Cherkasska Chernihivska Chernivetska Dnipropetrovska Donetska Ivano-Frankivska Kharkivska Khersonska Khmelnytska Kirovohradska Krymska Kyivska Luhanska Lvivska Mykolaivska Odeska Poltavska Rivenska Sumska Ternopilska Vinnytska Volynska Zakarpatska Zaporizhska Zhytomyrska
City:
Street and Number:

Electronic Contact Information:

	Canada	Ukraine
Telephone:
Fax:
Cellular:
E-mail:

Business Type and Sector:
Number of Employees:
Approximate number of trips to Ukraine each year:

How can CUBIChamber help you?

Membership Type: Corporate Individual Student

Pricing Corporate: $750.00 + $52.50 GST = $802.50 Individual: $300.00 + $21.00 GST = $321.00 Student: $50.00 + $3.50 GST = $53.50 (please remit amount to the address at top)

Press "Register" to submit the form

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