NS – Membership Challenge Order Form Name(Required) First Last iMIS Number(Required) Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone(Required)Email(Required) Enter Email Confirm Email I referred the following for Membership:(Required)Enter name of referral. First Last Do you have the I “heart” Nova Scotia Crest?(Required) Yes No CAPTCHAIf a CAPTCHA error occurs, try opening the form in a Private Browsing or Incognito Tab. You can also try clearing your browser cache (cookies). We recommend completing our forms on a desktop computer, using Chrome or Firefox.