Membership form

Signing up is easy!  Just fill up the following form and click the submit button at the bottom of the page.  None of the information you supply will be sold or distributed in any way.  To ensure authenticity, you will be contacted via e-mail for confirmation and payment details.  It's only $25 per year, so go for it!

NOTE: If you are retired, type RETIRED in all school-related fields.  In addition, you will become an honarary member and there is no membership fee.

Title / Salutation:  Mr.   Mrs.   Ms.
Full Name:
School:
School Board:
School Address: Address
City
Postal Code
School Phone #:
Home Address: Address
City
Postal Code
Home Phone #:
E-Mail:

I agree to have my name, school telephone number, and e-mail address entered into the QBTA Directory and published on the website

Yes   No

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