CVB – AAAS BOARD MEMBER PURCHASE Step 1 of 2 50% InstagramThis field is for validation purposes and should be left unchanged.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 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 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.
