SIPA MEMBERSHIP APPLICATION

Please print this form, complete the information, and mail it with a cheque for your membership fee to SIPA.

When we have processed your application, you will be issued a receipt and a members password that enable access to the Members' Pages.

Cheques must be made payable to:

Small Investor Protection Association
7791 Ninth Line
Markham, ON
L6B 1A8

We regret that we cannot accept payment by credit card.

Contact Info

Are you currently employed in the financial services industry?
Yes No

If so, in what capacity?

Current Employer:

Position/If retired last position:

Do you have a complaint? If yes, with whom?

Have you made your complaint in writing?
Yes No

Have you made a complaint in writing to a regulatory authority?
Yes No

Are you in litigation?
Yes No

Comments:

Would you like to Help?

Contact Stan Buell at 416-614-9128 or e-mail sipa.toronto@gmail.com .

My annual membership fee ($20.00 per family)

is enclosed

is forthcoming