Membership application form"*" indicates required fields1Applicant Info.2Company Info.3EMD Info.4Statistical Info. 5Annual Portfolio Info.6AuthorizationPrimary Contact Info.* First Last Primary Contact Phone*Primary Contact Email* Primary Contact Job Title*Secondary Contact Info. First Last Secondary Contact PhoneSecondary Contact Email Secondary Contact Job TitleCompany name*(as registered with securities commission)Year of incorporation*Company address* Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Company Phone Number*Company Fax Number*Website URL* Number of Employees*Number of Offices*Number of Dealing Reps*Registered with* Exempt Market Dealer Registered Portfolio Manager Investment Fund Manager OtherJurisdiction your firm is registered* Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut YukonList your Firm's Managed Funds*Exact Market Dealer (EMD) Info.*EMD Name# of years as EMDContact NameTitleRelated Entity? Y/NPhone #Email Add RemoveOther Registered Dealers/3rd Party EMDs*Dealer NameCat. (EMD, IIROC, etc)Contact NameTitlePhone #Email Add RemoveKey Individuals*Full NameJob TitlePhone #Email Add RemoveThe following information will be used to quantify and substantiate the representation of CAMLA and will not be used to disclose individual company information.Under Administration*# of Mortgages*In an Investment Pool*# of Mortgages*In Syndication*# of Mortgages*Residential Property*# of Mortgages*Commercial Property*# of Mortgages*Land Only*# of Mortgages*Construction*# of Mortgages*Other (leases, personal, etc)*# of Mortgages*By Province*Province Name(s)CA$ Amount# of Mortgages Add Remove*% Share First Mortgage - % of your total portfolio concentration in first position mortgages.Annual Portfolio Information*Year Ended% of Annual ReturnTotal Assets ($M)# of MortgagesLoan to Value %% Share 1st Mortgages Add RemoveCopyright*Do you grant permission to CAMLA to photograph and/or videotape and/or audiotape me in the course of participating in any and all CAMLA events to use your name and any of these photographs and/or videotapes for CAMLA purposes in any membership media and territory? Yes NoCAMLA News and Updates*By submitting your personal information you agree to receive emails from CAMLA news, media offers and developments that we think may interest you. You can always change your preferences anytime by selecting Email Preferences when we send you emails. Yes NoDisclaimer*I understand and agree that the contact information I have provided will be displayed on CAMLA’s website (brokers & associates only), and in CAMLA’s annual membership directory. I have read, understand and agree to abide by CAMLA’s best business practices, professional standards of practice and bylaws, including the Code of Ethics and the policies of the Association. These documents can be read on CAMLA’s website at: https://camla.ca/ I understand and agree that if I breach the approved Standards of Professional Conduct, I can be subject to an ethical procedure. I acknowledge that by submitting this form, I am giving CAMLA consent to use the information supplied for membership and the purposes specified. I hereby authorize CAMLA to make all inquiries necessary to verify the accuracy of statements made herein. I understand that the CAMLA Board of Directors reserves to right to deny membership or renewal and should my application be denied, I will receive a refund of my application fee. I acknowledge that if my application is denied, I have the opportunity to re-apply as outlined in the Association bylaws. I have read and accept the terms & conditions set forth in the disclaimer above.EmailThis field is for validation purposes and should be left unchanged.Δ