TelecomPioneers of Canada Membership Application

This on-line form is for employees and retirees of former Pioneer sponsor companies of Bell Canada, Nortel, MTS, AGT and BCTel who wish to join the Canadian Pioneers team.  If you would prefer to complete a paper copy, please return to the membership page and click on the link for the printed version.

Correspondence can be addressed to:

TelecomPioneers of Canada
PO Box 880
Halifax, Nova Scotia
B3J 2W3

Membership dues are $22.00 annually to the age of 55.  After that, you are considered a Life Member and are exempt from payment of dues.

CONTACT INFORMATION:
First Name:  
  		Initial:
Last Name: Preferred Name:

Home Address:
Address: City:

Province:

Postal Code:
Telephone:    Date of Birth: *optional
If you were recruited by someone - please type their name here:  

Spouse or partner's info:
First Name; Last Name:

Work Information:
Company: City/Town:
Province: Email Address:* *required
Comments:
  Click here if you want to be excluded from external direct mail or telemarketing fundraising initiatives. (We do not sell our membership lists, but do partner with benefit providers from time to time to provide services to our members).