Exit this survey >> Affiliate Membership Application Form Question Title * 1. Organization/Company Name Question Title * 2. Primary Contact Name Question Title * 3. Title Question Title * 4. EMail Question Title * 5. Phone Question Title * 6. Mailing Address Question Title * 7. FAX Question Title * 8. Business Type? Type Business Local Government Regional District First Nation Telcommunication Oil & Gas Hydro Transmission or Distribution Rail service Other Business Type menu Other (please specify) Question Title * 9. Describe your business Question Title * 10. Does your organization wish to access ICIS data (If the answer is "NO" go to question #17) NO YES Question Title * 11. How will the ICIS Member data be used? (Note: Please read the "General Terms and Conditions" and "ICIS Membership Policy") Question Title * 12. What areas of the province are of interest to your company ALBERNI CLAYOQUOT RD RURAL BULKLEY NECHAKO RD RURAL CAPITAL RD RURAL CARIBOO RD RURAL CENTRAL COAST RD RURAL CENTRAL KOOTENAY RD RURAL CENTRAL OKANAGAN RD RURAL COLUMBIA SHUSWAP RD RURAL COWICHAN VALLEY RD RURAL EAST KOOTENAY RD RURAL FRASER FORT GEORGE RD RURAL GREATER VANCOUVER RD RURAL ISLANDS TRUST KITIMAT STIKINE RD RURAL KOOTENAY BOUNDARY RD RURAL MOUNT WADDINGTON RD RURAL NANAIMO RD RURAL NORTH OKANAGAN RD RURAL OKANAGAN SIMILKAMEEN RD RURAL PEACE RIVER RD RURAL POWELL RIVER RD RURAL SKEENA QUEEN CHARLOTTE RD RURAL SQUAMISH LILLOOET RD RURAL SUNSHINE COAST RD RURAL THOMPSON NICOLA RD RURAL Comments Question Title * 13. What data does your organization/company own and is willing to share with ICIS Members? Question Title * 14. How often will the data be updated and delivered to ICIS? Monthly Quarterly Currency Currency Monthly Currency Quarterly Other (please specify) Question Title * 15. Will there be any restrictions on the data other than those imposed by the DSLA? Question Title * 16. Additional Comments Question Title * 17. Name of Signing Authority Question Title * 18. Title Question Title * 19. Address - if different than above Question Title * 20. EMail - if different from above Question Title * 21. Phone - if different from above Question Title * 22. Fax - if different from above Next >>