CVB – AAAS BOARD MEMBER PURCHASE Step 1 of 2 50% Agricultural Society Name(Required) Please set up an administrator- the person who will provide the information to the board on how to access the course, and follow up to ensure members have completed the program. **the administrator will not receive the program unless included as one of the members**CVB Administrator Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Board Member DetailsBoard Member #1 First Last Board Member #1 Email Board Member #2 First Last Board Member #2 Email Board Member #3 First Last Board Member #3 Email Board Member #4 First Last Board Member #4 Email Board Member #5 First Last Board Member #5 Email Board Member #6 First Last Board Member #6 Email Board Member #7 First Last Board Member #7 Email Board Member #8 First Last Board Member #7Board Member #8 Email Board Member #9 First Last Board Member #9 Email Board Member #10 First Last Board Member #10 Email Date(Required) MM slash DD slash YYYY Signature(Required)I agree to the terms and conditions: CVB PAYMENT $200(Required) Pay by Credit Card ($200) Pay By Cheque ($200) Total: $200 - Pay By ChequeTotal Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Payment Notice: Please note, upon submission payment is required before your purchase is complete. If you would prefer to pay by check Please send a check to: Alberta Association of Agricultural Societies Suite 108, J.G. O’Donoghue Bldg., 7000 – 113 Street, Edmonton, AB T6H 5T6. If you wish to pay online, please use the online payment form on this page. CommentsThis field is for validation purposes and should be left unchanged.
