Affiliate Membership Application

This is the application form for an Affliliate membership. If you have any questions, please contact Zaria Pucknell at zaria@rgd.ca

Account Information

First name

Last name

Email Required field: Enter valid email address

Paperless mailings

Profile URL This will generate the URL to your Directory Listing after your Membership is approved.
For example, if you entered, 'my-name' in this field, your URL would be like so:
https://rgd.ca/members/portfolio/my-name Required field: Enter a unique RGD URL to appear after https://rgd.ca/members/profile/[my-name]

Phone Required field: Enter valid phone number

Website Warning: All links need to start with http:// or https://

Mailing Address

Company Name (if applicable)

Street Address

Secondary Street Address

City

Province

Other Province/State

Enter the full name of your province/state

Country

Postal Code

Billing Address

Same as mailing

Company Name (if applicable)

Billing Street Address

Billing Secondary Street Address

Billing City

Billing Province

Other Billing Province/State

Enter the full name of your province/state

Billing Country

Billing Postal Code

Employment

Job Title

Company

Personal Information

Pronoun

Display pronoun on public profile

Identity collected privately

Please describe any intersectionalities that are important to your identity. (We plan to use this information to better understand RGD's Membership and ensure we are accessible, relevant and inclusive to all. This information will not be shared publicly.)

Socials

Paste the full url to your social media account. For example: "https://www.instagram.com/rgdcanada/"

Behance Warning: This field accepts URLs only. All links need to start with http:// or https://

Dribbble Warning: This field accepts URLs only. All links need to start with http:// or https://

Facebook Warning: This field accepts URLs only. All links need to start with http:// or https://

Instagram Warning: This field accepts URLs only. All links need to start with http:// or https://

LinkedIn Warning: This field accepts URLs only. All links need to start with http:// or https://

TikTok Warning: This field accepts URLs only. All links need to start with http:// or https://

Twitter Warning: This field accepts URLs only. All links need to start with http:// or https://

Payment

The annual fee for the Affiliate membership is $300 based on a 12 month membership. You will be prompted to make payment upon submission of this form.

(in Canadian dollars, does not include sales tax based on your location within Canada. There is no tax outside of Canada)

Next Steps

Applications are reviewed to ensure information is accurate and treated as confidential and will not be disclosed to any person who is not a part of the review process.

You will be redirected to complete payment after the application is submitted.

All applications need to be approved, so you will not be able to log into your account immediately. Applications are approved during regular office hours.