MembershipDescription Membership Benefits Committee ParticipationVoting RightsPrograms & InitiativesCompliance SupportMembers Only AreaMedia CampaignsGovernment RelationsMore to be added...1 Company2 Additional Information3 Agreement4 MembershipBusiness Activity Retail Location Distributor ManufacturerPrimary ContactCompany Name*First Name*Last Name*Username*Set Membership Password* Enter Password Confirm Password Strength indicator Primary Email Address* Phone*Address*Suite / Apt.City*Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code*Secondary ContactFirst Name*Last Name*Email Address* Phone*I Prefer Communication in*EnglishFrenchUpload High-Res LogoAccepted file types: jpg, png, eps, ai, ps.Consent I agree to allow my logo to be used on the VITA websiteWould You Like to Join a VITA Committee? Membership Communications Government Relations Project & Initiatives OtherTell Us How You'd Like to Get InvolvedWhat Issue(s) are most important to you?* Youth Uptake Prov / Fed Regulations Compliance Public Perception Standardization of Products Harm Reduction OtherTell us more....VITA Membership AgreementPrinciple TermsThe agreement starts as soon as your party has signedMembership starts on the Membership start dateMembership can be cancelled at any time by calling, or e-mailing Executive CoordinatorMembers are entitled to all rights and privileges offered by VITAThis agreement is non-transferableFees and Charges (Direct Debit) The fee relates exclusively to the membership of VITAAll payment for membership is due upon signing of membership agreementPayments will be automatically debited from the account you sign up underIf you fail to pay the amount due under this agreement for a period of more than 30 days, you may have your membership revoked until the amount is paid in fullYou agree to advise us promptly of any change to the member details providedMembership payments are non-refundableA member whose membership is terminated shall forfeit all the privileges of membership with immediate effect, there will be no entitlement to refund of any monthly membership charges already paid.For the avoidance of any doubt, any member who cancels membership in good standing and chooses to re-join can do so without payment penalty.Please familiarize yourself with the bylaws of VITA which can be found here.By joining the Association, you agree that your membership is subject to the bylaws and any codes of conduct or other policies established thereunder.Is your company owned in whole or in any part by a tobacco company or a subsidiary of a tobacco company?YesNoSignature*By signing my name below I agree to the above terms and conditions.Signed On This Date:* Date Format: MM slash DD slash YYYY Membership FeesDistro / Manufacturer: 1-3 Employees$1504-8 Employees$2759-15 Employees$37516 or more$500Retail Locations:1 Store$802 Stores$1403 Stores$2004 or more$250Business Type* Retail Business Distributor ManufacturerRetail - Choose Number of Locations1 Store2 Stores3 Stores4 or MoreChoose Number of Employee's1 - 3 Employees's4 - 8 Employee's9 - 15 Employee's16 or moreTotal Monthly Fee $ 0.00 CAD * I agree to the Terms & ConditionsCredit CardMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
