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       The Student Life Education Company

Become a BACCHUS Member

Level
BACCHUS Canada Member ($175.00 (CAD)) Subscription period: 1 year, on: May 1st Automatic renewal: no

 

Fill in application form

Application form

* Mandatory fields
 

 

*First name
*Last name
*Organization
*e-Mail
Phone
*Password
 
 

Personal information

Title
*Depatment/Club
Fax
 

Contact data

*Address
*City
*Postal code
*Province/State
Courier Address (if different from mailing address)
 

If you wish, you can include two additional email to recieve BACCHUS correspondance & announcements

Email 1
Email 2
 

Additional Information

Renewal status
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The Student Life Education Company
Charitable Registration # 88639 3594 RR0001