Member Information Form

1GENERAL INFORMATION ON MEMBER COMPANIES:

2YOUR COMPANY REPRESENTATIVE

3CCSPA COMMITTEES

4PROFILING YOUR COMPANY

GENERAL INFORMATION ON MEMBER COMPANIES
ARE YOU A:*
Check all that apply
- Manufacturer
- Supplier
- Distributor
- Consultant
- Importer
- Other
Please Specify:*
Company Name:*
Types of products or services sold in Canada:*
Number of manufacturing plants and locations (including postal code) in Canada. This helps CCSPA identify elected officials for each location, which we use in our advocacy efforts:*
Location Postal Code
The following information will be kept confidential and will be rolled up for our Imagine Life Without Us one-pager
Number of Employees in Canada:*
Your Sales in Canada for the Previous Year:*
Your Sales for Exports for the Previous Year:*

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COMPANY REPRESENTATIVES
Official Representatives will receive bulletins and emails sent to ALL members of CCSPA
Full Name:*
Email*
Phone*
Fax
Address*
Street Address Mailing Address (if different from above) City State / Province / Region ZIP / Postal Code
- Add a Second Representatives
SECOND COMPANY REPRESENTATIVES
Full Name:*
Email*
Phone*
Fax
- Add a Third Representatives
THIRD COMPANY REPRESENTATIVES
Full Name:*
Email*
Phone*
Fax
- Add a Fourth Representatives
FOURTH COMPANY REPRESENTATIVES
Full Name:*
Email*
Phone*
Fax

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CCSPA COMMITTEES
To participate in and/or receive all correspondence pertaining to a committee, please provide the name of your company representative(s), their phone and fax numbers and their email addresses.

Registered Products Committee (RPC) (Issues: pest control products, antimicrobials, biocides)

Specialty Products and Environment Committee (SPEC) (Issues: CEPA, Chemicals Management Plan, post-consumer waste, VOCs, GHS)

Public Affairs Committee
CCSPA COMMITTEES REPRESENTATIVES
You may enter more than one committee per representative.
Full Name Phone Fax Email Committee Name(s)

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PROFILING YOUR COMPANY
Our members are listed on the CCSPA website – most members are linked to their company website. If you want us to link your company name to your company’s website, please provide your company’s website address below:
Website Address:
Sustainability - Is your company working towards a sustainable future? We profile members’ sustainability efforts on our website and would like to include yours.*
- Yes
- No
Please provide the url address for your company’s sustainability efforts:*
CCSPA Membership Fees for January 1 – December 31, 2021
*
- I certify that our company's gross sales relating to consumer, industrial and institutional specialties fall under a Category (select below) as per the CCSPA Membership 2021 Fees Schedule.
Please use CCSPA’s Membership Fees Calculator to verify your fee and insert the amount below:
Fee Amount:*
*Please add GST/HST to your Fee Amount
Category*
Signature of Official Representative*
Send your payment by wire/bank transfer to:

CCSPA
800-130 Albert Street
Ottawa, Ontario K1P 5G4

(HST # R108075490)
To obtain CCSPA's wire/bank transfer information:
Please contact Nancy Hitchins at 613-232-6616, ext. 12, or by email at hitchinsn@ccspa.org.
NOTE: US members – please remit your fee in Canadian dollars.
EXTRACT FROM CCSPA BYLAWS, ARTICLE I
Section 2 Classes of Membership

Membership in the Association shall consist of the following type:

(a) Active Membership

Active Members

Any individual, partnership, firm or corporation which carries on in Canada the manufacture, processing, distribution, marketing, dispensing, application, consulting, or packaging of consumer, industrial, and institutional specialty products shall be eligible for Active Membership.

Any individual, partnership, firm or corporation engaged, in Canada, in the business of supplying equipment, devices, containers, raw or other materials, or services for or in respect of those articles listed above shall be eligible for Active Membership.
SEND FORMS TO CCSPA
By clicking "Send Form to CCSPA", your forms will be sent to Nancy Hitchins, Director, Administration & Member Services, CCSPA. Questions: Contact Nancy Hitchins at 613-232-6616, ext. 12, or via email at hitchinsn@ccspa.org.
Send me a copy of this membership form?
- Yes, I would like a copy of this membership form?
Email*
Email
This field is for validation purposes and should be left unchanged.

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Location	Postal Code

Full Name	Phone	Fax	Email	Committee Name(s)

CCSPA Member Information FormThis form must be completed by all members.

GENERAL INFORMATION ON MEMBER COMPANIES

COMPANY REPRESENTATIVES

SECOND COMPANY REPRESENTATIVES

THIRD COMPANY REPRESENTATIVES

FOURTH COMPANY REPRESENTATIVES

CCSPA COMMITTEES

PROFILING YOUR COMPANY

CCSPA Membership Fees for January 1 – December 31, 2021

Send your payment by wire/bank transfer to:

To obtain CCSPA's wire/bank transfer information:

NOTE: US members – please remit your fee in Canadian dollars.

EXTRACT FROM CCSPA BYLAWS, ARTICLE I

SEND FORMS TO CCSPA