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Secondary Email
*Email Address
*Password
* Re-Enter Password
*First Name
*Last Name
Middle Name
Prefix
Gender (for demographic purposes)
Birthdate (if using the calendar, select year, month, then day)
Membership number:
FCG Election Date
ACG Election Date
Date of achieving GradCG:
Date of achieving Acc.Dir.
Date of achieving P.Adm.
Additional designations
Employment Information Let us know if your status has changed from what we have listed below.
Company
Title
Industry of Employment
Sector of Employment
Business Phone
Business Phone Extension
Business Fax Number
Expected year of retirement (4-digit year, demographics only)
I want my employment address information shared in the Membership Directory, once formed on the new site.	True False
Mailing Address Information Please enter your preferred mailing addresses below:
*Home Phone
Home Fax
Mobile Phone
Would you allow us to send you text messages?	Yes No
Text Messaging If you would like us to send communications via SMS please choose your mobile carrier below. If your mobile carrier is not listed please check the My Carrier is Not Listed check box.
*For texting purposes please select your mobile carrier	By selecting a carrier, I wish to receive text messages and understand carrier charges may apply.
My Carrier is not listed
*Mobile Carrier Other

Primary Address 1
Primary Address 2
Primary Address City
*Primary Address Province
Primary Address Country
Primary Address Postal Code
Secondary Address Province

LinkedIn URL

Facebook URL
Twitter
Twitter Handle
How did you hear about CGI of Canada?
* Which Conference?
* Which Division?
* Which Division?
Who referred you?
* What did you attend?
* Who referred you?

*I confirm that the information above is accurate and current.

Employment Information

Mailing Address Information

Text Messaging