Membership Inquiry Form

NAME OF FIRM OR ORGANIZATION*

REPRESENTATIVE’S EMAIL ADDRESS*

DESIGNATED REPRESENTATIVE

REPRESENTATIVE’S TITLE

BUSINESS TELEPHONE

BUSINESS FAX

MEMBERSHIP TYPE SOUGHT

FULL ASSOCIATE

ARE YOU A MEMBER OF A RECOGNIZED GRAIN EXCHANGE IN THE UNITED STATES AND/OR THE DOMINION OF CANADA?

YES NO

IF YES, OF WHICH EXCHANGE ARE YOU A MEMBER?

BUSINESS WEBSITE

BUSINESS STREET ADDRESS

PLEASE GIVE A BRIEF DESCRIPTION OF YOUR BUSINESS.

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