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Apply for Membership
Application Form for Associate Corporate Membership
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Phone
This field is for validation purposes and should be left unchanged.
General Information
Name of Firm
*
Address
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Mailing Address (if different)
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Contact Information
Contact Person
Title
Telephone
Email Address
Web Site
Firm Details
This firm is a:
Sole Proprietorship
Partnership
Corporation
Date of commencement of operations:
MM slash DD slash YYYY
Percentage of firm held by other corporations, partnerships or non-employee individuals:
(If 50% or more, please provide details in cover letter)
Please enter a number from
0
to
100
.
Does the firm or its principals hold a majority interest in any other consulting, inspection or testing firm?
(If yes, please provide details in cover letter)
Yes
No
Indicate whether the firm or its principals are associated with any of the following institutions or firms:
(Please check all that apply and provide pertinent details of affiliation in cover letter.)
Academic
Government
Industry
Manufacturing
Other CCIL member Firm
Other non-Member Consulting, Testing and Inspection Firms
Trade Group
Executive officers and/or full-time professionals
List executive officers and/or full-time professionals
List executive officers and/or full-time professionals
Name
Title
Degree
Add
Remove
Attach resumes
Drop files here or
Select files
Accepted file types: pdf, doc, docx, Max. file size: 25 MB.
Are the executive officers or professionals listed above engaged full-time in the operations of the firm?
Yes
No
If not, what proportion of their time do executive officers or listed professionals spend on operations of the firm?
If not, what proportion of their time do executive officers or listed professionals spend on operations of the firm?
Officer
% of Time
Add
Remove
Branch Laboratories and/or Offices
Branch #1
Name of Firm (Branch):
Address
Contact Person
Title
Phone
Email
Branch #2
Name of Firm (Branch):
Address
Contact Person
Title
Phone
Email
Is each branch owned in full by the same owners as the primary operation?
(If no, please explain in cover letter)
Yes
No
Is any branch operated as a separate corporate entity?
(If yes please explain in cover letter)
Yes
No
Number of employees based on monthly payroll average for the 12 months prior to this application (including all part-time, full-time, temporary and permanent professional, technical, and administrative staff)
Please enter a number greater than or equal to
0
.
List professional memberships, affiliations, qualifications, certifications and/or accreditations held by the firm or staff members.
Scope of Services
Describe briefly the consulting, testing and inspection services offered by your firm.
Reference
List one CCIL member sponsor or three client references who may be contacted by CCIL.
List one CCIL member sponsor or three client references who may be contacted by CCIL.
Company
City
Contact Person
Telephone
Add
Remove
Division
Indicate the division under which you wish to be included.
Geotechnical and Construction Materials
Environmental and Life Sciences
Delegates
List company representatives delegated to attend meetings and eligible to hold office.
Agreement
I have read the Summary of Conditions of CCIL Membership, Code of Ethics and the Schedule of Dues and attest that:
the information given in this application is true and correct as of the date of application;
the applicant firm will adhere to all the requirements of the Conditions of Membership and Code of Ethics, and;
the applicant firm will accept the decision of the Board of Directors with respect to this application
Name of authorized Officer and title
Date
YYYY dash MM dash DD
Signature
Max. file size: 80 MB.
Dues for the full year are to be submitted with the membership application. Adjestment will be made on the following year's dues depending on the number of months between start of membership and December 31.
Cheque covering annual dues plus applicable GST/HST in the following amount is being mailed.
(Note: Payment can also be made by EFT or Interact e-transfer, Contact CCIL’s Head Office for instructions.)
Uploads
Cover letter, as required
Max. file size: 80 MB.
Resumes
Max. file size: 80 MB.
Brochures
Max. file size: 80 MB.
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