Supply Management Training (SMT)

Diploma Program Enrolment Form

Please submit this form to:

SCMA Alberta Office, Mayfield Business Centre Suite 100, 10525 – 170 Street NW Edmonton, AB T5P 4W2

Tel: (780) 944-0355 (in Edmonton Area) Fax: (780) 944-0356 Toll Free - 1-866-610-4089 Email: mgutierrez@scmaab.ca

Please enter your name how you wish it to appear on your Diploma

Last Name First (Given) Name Middle Name(s) Membership ID#

Home Address City/Town Province Postal Code

Telephone (Home) Telephone (Business) Fax Email

Employer Job Title

Business Address City/Town Province Postal Code

What is your preferred mailing address? Home Business

Enrolment Fee $150.00+GST

If you are not currently a member, but wish to become one, please submit the Membership Application Form.

Payment Options

Cheque

Money Order

Please make payment to SCMA Alberta

VISA

MasterCard

AMEX

Purchase Order

(Please attach copy)

PO#

Payment Enclosed

Enrolment fee:

GST:

Total:

Credit Card number Expiry Date Name on Card

Signature

Office Use Only Batch #

Auth #

Trans #

Date Processed

Information collected is done in accordance with Canadian privacy laws. It will be used for the purpose of registration into

SCMA AB’s Supply Management Training (SMT) Diploma Program. It will not be used or disclosed for other purposes.