Membership Form

Fill out the form below to submit your pledge.

Member Information
Billing Name:
Member Name:
Phone:
Address:
City:
Province/State:
Postal Code/Zip:
Country:
Email Address:
Favourite CIUT Show:

Membership Pledge

(A tax receipt will be issued for all contributions of $25.00 or more.) Membership gifts are listed below.
$25+
$30
$40
$50
$60
$75
$80
$90
$100
$110
$120
$130
$140
$150
Above $150: (eg. 199.99)

Gifts
For those donating $75 or more, please choose a t-shirt size: No Gift Necessary
T-shirt size S
T-shirt size M
T-shirt size L
T-shirt size XL