Personal Information

First Name *

Last Name *

Position/Title *
If not applicable, type n/a

Organization Name *

Address Information

Address *
Street number & name

Suite, office, P.O., Floor etc.

City *

Province Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon -- Outside Canada --

Postal Code *
If outside Canada, include your ZIP

Country

Region * Choose oneEastCentral EastCentral WestNortheastNorthwestSouth WestTorontoProvince-wideCanada not OntarioOutside Canada
View MAP (PDF) to find or check your region

Contact Information

Telephone *
Area code / phone number / extension

Toll Free

Fax

Email *

Website www.website.com

Membership Type

Membership Type * Organizational Individual

Name of Organization Member (if different from above)

Sector *

Please tell us what sector(s) you or your organization represent. Select all that apply, and/or choose 'other'.

Agriculture/Farming Food Processing, Distributing, Shipping Health Environment Education/Schools Municipal Government Provincial Government Federal Government Economic Development Community/Social Private Sector

Other:

Contact Permission *

FoodNetOntario will only use the above information to contact you on membership-related issues. FoodNetOntario does not sell, rent, lease, or loan any personally identifying information to outside organizations or groups. As part of your welcoming email, we will invite you to join various communication vehicles used by FoodNetOntario to help keep you informed about issues relating to Food Security.

Are you willing to share your contact information with other FoodNet Ontario members?
This information will be in a password protected area of the website.

Yes No

or cancel