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: [email protected] 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.