New Member Registration Form

To apply for membership in CCI, the Ontario Presenting Network, please complete the following:

*indicates a required field

Membership Status*:

I am a new member to CCI
I am renewing my CCI membership

Name*:
(Theatre/Venue/Organization)

Designated Contact*:

Title:

Address*:

City*:

Province/State*:

Postal Code*:

Phone*:

Ext. Alternate Phone:

Fax:

E-mail*:

Website:

*Membership Category:

Select the appropriate Presenter, Consortia or Industry membership category below based on your Artist Fee Budget (AFB) for Presenters, or Ontario Touring Receipts (OTR) for Artist Managements.
For all other categories select the membership best suited to your needs.
Benefits for each category are viewed by clicking on the category name.
Register your staff and colleagues as Associate Members of CCI (see below).
NOTE: GST is applicable and will be added to the membership fee when you SUBMIT this form. You will see your grand total on the Verification Screen/Invoice page when you hit SUBMIT

PRESENTING MEMBER:
(PLEASE select the appropriate box)

Presenter or Consortia Member

CCI FEE

Artist Fee Budget (AFB) Under $10,000

$ 75.00

Artist Fee Budget (AFB) Over $10,000 $ (Enter AFB ) Please do not enter the $ sign.
(Calc. is AFB x 0.15% + $75 base fee to a maximum of $375)

$ TBD (auto calculation on submit)

INDUSTRY MEMBER:

Type A: Industry - Artist Representative (Agent/Management):

Type B:


	Ontario Touring Receipts (OTR) Under $500,000 $ (Enter OTR) Please do not enter the $ sign.	$ 125.00
	Ont. Touring Receipts (OTR) Over $500,000 $ (Enter OTR) Please do not enter the $ sign. (Calc. is OTR x 0.025% + $125 base fee to a maximum of $375)	$ TBD (auto calculation on submit)

	Industry - Business/Consultant	$125.00

ASSOCIATE MEMBER(S):

Associate Member x (# of members) @ $50 each
(please complete the associate member information area)

$ TBD (auto calculation on submit)

Associate Member Information Area

Associate #1
Name:	Title:
E-mail:	Tel:	Ext.
Associate #2
Name:	Title:
E-mail:	Tel:	Ext.
Associate #3
Name:	Title:
E-mail:	Tel:	Ext.
Associate #4
Name:	Title:
E-mail:	Tel:	Ext.

ARTIST MEMBER:

Artist

$125.00

SUPPORTING MEMBER:

Supporter

$125.00

STUDENT MEMBER:

Student

$25.00

Notes:

Obligations of Membership*

I AGREE

You must CLICK HERE to read the Obligations of Membership Agreement.

I have read and understand the obligations as they are outlined on the page as noted in the above link.

PAYMENT:

I will be paying online by Credit Card

STEP 1	(check the box to pay by credit card)
STEP 2	(After you SUBMIT this form, you’ll see a link to the secure Credit Card payment area at the bottom of your Verification/Invoice screen. You must click on that link to access the Credit Card Payment Screen.)
STEP 3	(On the Credit Card Payment screen, fill in your credit card information in order to complete your Membership Registration.)

I will be paying by Cheque (Payable to: CCI - COMMUNITY CULTURAL IMPRESARIOS )

Send your payment to:
CCI
Centre for Social Innovation
215 Spadina Avenue, Suite 125
Toronto, ON M5T 2C7
(Your receipt will be mailed to you)

Any personal information you choose to provide on the CCI Membership Registration form is collected in compliance with Bill C-6 – PIPEDA (Personal Information Protection in Electronic Documents Act). The information will be used to contact you in fulfillment of your CCI Membership, and will be handled in accordance with CCI’s Privacy Policy (available for viewing on the CCI website www.ccio.on.ca/privacy.htm). Please contact the CCI Privacy Officer with any questions.