Download a Printable Membership Application Form Here Or complete this online form for easy and convenient online payment: Membership Application First Name:* Last Name:* Member Since (year): Email Address: Address: (for mailing correspondence – i.e. certificates)* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone: Cell Phone: Other Phone: Other Interests: Member of PPGAM Group on Facebook Member of Other Associations/Groups (i.e.) CKC, MAHTA, St. John Ambulance Therapy Dog, etc. If so, please enter which group(s): Business InformationBusiness Name: Business Address: (for inclusion on membership list) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone (Work):Fax:Website (if applicable): Other Phone (if applicable):Service Type: Select All Shop Mobile Both Daycare Boarding N/A I groom: dogs cats other I am a: (select 1 – 2 most applicable titles): bather novice / student groomer business / shop owner CERTIFICATION LEVELS OBTAINED: (please select all that apply)Canadian Professional Pet Stylist Certification Levels CCST1- Canadian Canine Stylist Technician CCST1-Int- Canadian Canine Intermediate Stylist CCS2- Canadian Canine Stylist – Sporting/Non-Sporting/Terrier CCMS3- Canadian Canine Master Stylist IPG Certification Levels CSP – Certified Salon Professional CPG – Certified Professional Groomer CAPG – Certified Advanced Professional Groomer ICMG – International Certified Master Groomer Does your business specialize in any specific grooming techniques?(ex. Creative, Hand Stripping, etc.):MEMBERSHIP APPLICATION / RENEWALConsent I give permission to the PPGAM to provide my business information as stated above to other members of the association and on any official PPGAM marketing material, such as the Member Directory.*NOTE: Memberships not renewed by the due date will default back officially to New Memberships.* New Membership $160.00 (includes insurance coverage) Membership Renewal $130.00 (due by September 30th each year) *NOTE: Memberships not renewed by the due date will default back officially to New Memberships.In accordance with PPGAM Bylaws – Article II, Section 2, Paragraph 1, I hereby declare that I have never been convicted of animal abuse. (Your electronic signature below by submitting this form constitutes a legal agreement.)Digital Signature:* Name Today's Date:* DD slash MM slash YYYY Please Click the Submit Button below to send us this form. Payment is required in full before your application will be processed.