*1.Have you been a CAGP member-in-good-standing for at least 3 months prior to the application deadline of February 6, 2023?(Required.)

Yes

No

*2.First Name(Required.)

*3.Last Name(Required.)

*4.Job Title(Required.)

*5.Organization/Company(Required.)

*6.City(Required.)

*7.Province(Required.)

*8.Telephone(Required.)

*9.Email(Required.)

*10.What CAGP local Chapter are you affiliated with?(Required.)