Become A Member Membership Level*Assistant Membership ($288.75 incl GST)Supervisor Membership ($393.75 incl GST)Would you like to include Insurance for $660 Yes No Section 1: Applicant DetailsFull Legal Name of Applicant* (including trade name if any):Mailing Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Name of Contact* First Last Phone*Email* Enter Email Confirm Email Years as a Licensed Display Assistant:* Age:* ERD License #* Please attach a copy of the FRONT & BACK of your ERD License* Drop files here or Select files Max. file size: 256 MB, Max. files: 2. Are you a Canadian Citizen?*YesNoDo you plan to obtain your Display Supervisor designation?*YesNoDo you have a mentor?*YesNoIf no, would you like to have one?*YesNoHave you ever been convicted of a felony?*YesNoPlease explain the Felony*Have you ever been involved in a reportable fireworks incident?*YesNoIf yes, please explain*Years as a Licensed Display Supervisor:* Section 2: ClaimsList any and all incidents, circumstances, acts, allegations, errors, omissions or facts which may result in or give rise to a claim against the Applicant, its subsidiaries, affiliates or predecessors in business? If none, please indicate "non" below.*In the last five years has any incident, circumstance, claim or complaint result in a fine, penalty, request or demand for action or any warning letter for any federal, provincial or local regulatory agency?*YesNoPlease explain:Section 3: Non-Owned or Hired AutomobilesEstimated annual cost of rented automobiles:* Type of Vehicle Rented (Van, Pickup, etc)* How often will each type of vehicle be rented and the average duration of each rental?*Number of Assistants using their automobiles for work on Applicants displays* Section 4: Operations, Sales and RevenuesEstimated number of displays and revenue for the next 12 months that include the following:Number of Shows NOT Requiring Endorsements* Gross Revenue From These ShowsRevenues for this purposes of this application are considered to be 'the show budget less the reimbursed product costsNumber of Shows Requiring Endorsements* Gross Revenue From These ShowsRevenues for this purposes of this application are considered to be 'the show budget less the reimbursed product costsDoes the Applicant have any endorsements to their license to utilize shells larger than 155mm/Flying Saucers(UFOs)/Nauticals or perform on floating platforms, rooftops, bridges or flatbeds?*YesNoDoes the Applicant perform any work with products that requires endorsements (listed in question above)?*YesNoDoes the Applicant perform/supervise indoor displays?*YesNoDoes the Applicant perform/supervise any special effects work?*YesNoDoes the Applicant perform/supervise work for the military? ie. special effects for training exercises*YesNoDoes the Applicant perform/supervise displays outside of Canada?*YesNoHave you been cited by any regulatory agencies for unsafe practices or controls within the past three years?*YesNoPlease explain:Are the imported fireworks used in your displays authorized for use by Canadian Government authorities (ERD)?*YesNoIf No: Please explainAre Fireworks Displays performed in compliance with Explosives Regulatory Division of the Ministry of Natural Resources regulations as outlined in the Display Fireworks Manual and Explosives Regulations, 2013?*YesNoIf not, please explainWill Fire Departments personnel be in attendance for each show?*YesNoIf no, please explainDoes the applicant: Agree to hold any dealers, distributors, manufacturers, or suppliers harmless & indemnified against claims/suits brought against them for bodily injury/property damage arising either directly/indirectly from the Applicant's operations (by agreement or contract)?*YesNoPlease provide a copyMax. file size: 256 MB.Does the applicant: Provide warranty or performance guarantees?*YesNoPlease provide a copyMax. file size: 256 MB.Does the applicant: Assume liability of others by agreement/contract?*YesNoPlease attach a copy of the FRONT & B of your ERD LicenseMax. file size: 256 MB.Does the applicant: Comply with Explosives Regulations, 2013, for fireworks storage before and after a display?*YesNoDoes the applicant: Comply with Explosives Regulations, 2013, regarding the max amount that can be stored prior to a display*(125kg or 500 e-matches without written approval)YesNoDoes the applicant: Have fireworks transported to your displays? Please explain who transports.*Does the applicant: Store fireworks at the display site in accordance with Explosives Regulations, 2013, and file a site plan including storage details?*YesNoDoes the applicant: Use fire prevention and first aid measures that minimize the possibility of harm to people or property?*YesNoSection 5: Signatures & PaymentsThe undersigned hereby declares that to the best of my knowledge and belief the above statements and particulars are true in every respect and that I have not withheld, omitted, misstated or misrepresented any material facts. The undersigned acknowledges that the insurer can relay on the information contained in this application and, if this application is accepted, agrees that this will form the basis of the association membership and the insurance contract prepared by the insurer.Please type your full name* By typing your full name into this field you are agreeing to the terms outlined above.Date of application* MM slash DD slash YYYY Payment Methods: Please make cheques payable to the Institute of Professional Pyrotechnicians, or E-transfers can be sent to admin@fireworksinstitute.net Total Amount to be paid: $288.75 + plus applicable sales taxes Next Steps: Once your registration and payment have been processed, you will be emailed a login and password for the website. This will unlock the memberships section of the site. Join us and other pyros here for videos, discussions, and events. Enjoy benefits, insurance certificates, the forum, related links, discounts and much more. Please allow up to 5 business days for membership application processing. Payment Methods: Please make cheques payable to the Institute of Professional Pyrotechnicians, or E-transfers can be sent to admin@fireworksinstitute.net Total Amount to be paid: $393.75 + plus applicable sales taxes Next Steps: Once your registration and payment have been processed, you will be emailed a login and password for the website. This will unlock the memberships section of the site. Join us and other pyros here for videos, discussions, and events. Enjoy benefits, insurance certificates, the forum, related links, discounts and much more. Please allow up to 5 business days for membership application processing. Payment Methods: Please make cheques payable to the Institute of Professional Pyrotechnicians, or E-transfers can be sent to admin@fireworksinstitute.net Total Amount to be paid: $918.75 + plus applicable sales taxes Next Steps: Once your registration and payment have been processed, you will be emailed a login and password for the website. This will unlock the memberships section of the site. Join us and other pyros here for videos, discussions, and events. Enjoy benefits, insurance certificates, the forum, related links, discounts and much more. Please allow up to 5 business days for membership application processing. Assistant Member Price: Supervisor Member (without Insurance) Price: Supervisor Member (with Insurance) Price: Total $ 0.00 CAD + plus applicable provincial sales taxes