Post on 02-May-2019
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.