Legal Business Name

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Company Website

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Main Contact Information

First Name

Last Name

Title

Phone Number

Phone Extension

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Language Preference

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Voting Contact Information

Voting Contact: Individual who is entitled to recieve notice of, attend and vote at all meetings of members.

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Company Details

Street Address

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Province/State

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Postal/Zip Code

Country

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Phone Number

Business Type Information

Please upload the documents below as applicable to your business

Document Type

Select One... Business License Business Registration Charitable Number Credentials Main Practitioner Credentials Medical Device Certification NFP Certificate Organic Certificate Product Licenses Site Licenses Student ID Vendor Permit

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Business Information

Please highlight what other industries your company services

What proportion (% of total income of each) of your sales revenue comes from these sectors

If applicable, please provide the license holder name associated with your NPN

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First Name

Last Name

Title

Phone

Email

Language Preference

Select One... Both English and French English French

Contact Type

Accounting Buyer Government Relations Main Contact Main Trade Show Marketing/Communications President/CEO/Owner Regulatory Secondary Trade Show Store Manager Voting

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Secondary Stores

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Add Additional Company/Retail Information

Store Location Name

Main Contact First Name

Main Contact Last Name

Street Address

City

Province/State

Select One... Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida FS Micronesia Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N Mariana Islands Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Island Virginia Washington West Virginia Wisconsin Wyoming Out of country

Postal/Zip Code

Country

Select One... Canada United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, The Drc Cook Islands Costa Rica Cote D'ivoire Croatia (local Name: Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (malvinas) Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (islamic Republic Of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, D.p.r.o. Korea, Republic Of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar (burma) Namibia Nauru Nepal Netherlands Netherlands Antilles Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia And South S.s. Spain Sri Lanka St. Helena St. Pierre And Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province Of China Tajikistan Tanzania, United Republic Of Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu U.s. Minor Islands Uganda UK Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (british) Virgin Islands (u.s.) Wallis And Futuna Islands Western Sahara Yemen Yugoslavia (serbia And Montenegro) Zambia Zimbabwe

Phone Number

Fax

Email

Is this a Franchise Location

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Where this application contains personal information about an individual, the applicant (i) hereby consents; or (ii) represents and warrants that the person concerned has consented to the collection, use and disclosure of the personal information by the CHFA for the purposes of processing this application, administering membership in the in the CHFA, communicating with applicants and members and other such purposes as described in CHFA's Privacy Policy. The applicant (I) hereby acknowledges; or (ii) has obtained an acknowledgement from the individual concerned, that: (a) CHFA's collection, use and disclosure of Personal Information shall only be done in accordance with its Privacy Policy, a copy of which is available at www.chfa.ca or from the CHFA by email by sending a request to privacy@chfa.ca.

Guiding Principles

Our guiding principles outline that:

1. The Canadian Health Food's (CHFA) members, staff and Board will act with integrity, honesty and in an ethical manner.
2. CHFA welcomes dialogue on divergent opinions that refrain from disparaging the CHFA, its members, staff or Board.
3. CHFA's members, staff and board will treat each other with dignity and respect.
4. CHFA believes in the spirit of cooperation and that we are stronger together.
5. CHFA's members, staff and Board will at all times act within the provisions of our bylaws.

Terms and Conditions

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Totals

Membership Dues:	$0.00
Discounts:	$0.00
Optional Subscriptions:	$0.00
Optional Donations:	$0.00
Optional Chapter Dues:	$0.00
Taxes:	$0.00
Final Total	$0.00