BOARD MEMBERSHIP APPLICATION FORM

COMPANY INFORMATION

Company Name *
   
Street Address *
   
Suite Number *
City *
   
Province/State *
   
Postal code/Zip code *
   
Country *
   
Organization Size by Gross Revenue *
   
Type of Company *
   
Industry Type *
   
Month of AGM/APM or Appointment Date of Directors *
   

MEMBER INFORMATION


The Board Membership fee allows for up to 15 members including senior executives (I.E. CEO, CFO, Corporate Secretary, etc.) plus the Administrator at no cost.

Fees for additional members are:

  • $200 per person for For-Profit and Commercial Crown boards
  • $100 per person for Not-For-Profit boards

Please note: Our Member Engagement Team will contact you to finalize your Board membership.


Please attach your board roster below.

We require the following information for each of your members:

  • Member’s First and Last Names
  • Preferred Title (Job title/Board title/Not applicable)
  • Preferred Mailing address (corresponding to Preferred title) – please indicate if work or home
  • Email address
  • Telephone number


Please CLICK HERE for a SAMPLE Roster.

Member Roster


   

Each Board Member Company is asked to select TWO contact people:

BOARD MEMBERSHIP ADMINISTRATOR


This is the individual from your organization who manages the membership roster, receives invoices and provides general administrative support for the Board Membership.

Prefix *
   
Name *
   
Current Title / Position *
   
Email *
   
Telephone (preferred) *
   
Ext. *


BOARD MEMBER ENGAGEMENT CONTACT


This board member is the person with whom ICD can engage with to provide tools and resources with an aim of improving the organization’s board governance practices.

Prefix *
   
Name *
   
Current Title / Position *
   
Email *
   
Telephone (preferred) *
   
Ext. *


GRANT OF RIGHT:


The Authorized Signatory agrees they hereby grant the Institute of Corporate Directors (ICD) permission to use the Board member Company’s name in any and all of ICD’s publications and public relations activities, including website and advertisements, without payment or any other consideration. In addition, the Company waives the right to inspect or approve the finished product, including written or electronic copy, wherein the Company’s name appears. Additionally, the Company waives any right to royalties or other compensation arising or related to the use of the name and board information. The company hereby holds harmless and releases and forever discharges the ICD from all claims, demands, and causes of action which the Company , its representatives, executors, administrators, or any other person acting on its behalf by reason of this authorization.


Do you agree?



   

TERMS & CONDITIONS

 

In order to become an ICD member, all applicants must read and agree to adhere to the ICD Code of Conduct. Once the board membership has been processed all individuals associated with the board membership will be sent and asked to agree to the ICD Code of Conduct. Membership with the Institute of Corporate Directors is paid annually, is non-transferable and non-refundable.

By clicking SUBMIT, you acknowledge that you are in agreement with the above Terms and Conditions.