APPLY FOR MEMBERSHIP MEMBERSHIP APPLICATION FORM Name of Company*"hereby applies to become a member of FCSA"Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Type of Telecommunications Service Provider* Local Telephone Long Distance Telephone Cellular PCS Hydro Utility CATV Internet Other (Specify) Number of Operating Microwave Radio Stations*Total Amount of Microwave License Fees paid to Industry Canada on April 1 of Current Year: $*Reason for Seeking Membership in FCSA*On behalf of Applicant - Name* First Last On behalf of Applicant - TitleSPONSORSHIP #1(Two required)Name* First Last Organization*SPONSORSHIP #2Name* First Last Organization*
