Membership Registration

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Primary Contact Information

CEO (or most Senior Executive in Canada that will be attending the meetings)

Company Information:

Assistant Contact Information:

Requested Information


1. As a member of the CEO Health + Safety Leadership Network, I agree to the following terms of participation:

At least 1 must be checked

2. Please provide a brief CEO commitment statement that can be added to the CEO H+S Leadership Network website and/or marketing collateral.

By submitting this form, you agree to the terms of participation outlined above, and give consent to share your company name and logo, as well as the CEO commitment statement in promotional and advertising materials and on the CEO Health + Safety CEO Leadership Network website. Please see our privacy statement here. CEO Health + Safety Leadership Network reserves the right to photograph its events, and from time to time we use these photos in our publications. By registering for any of our events, you understand and acknowledge that your photograph may be taken and used, per CEO Health + Safety Leadership Network discretion.

Thank you for taking the time to complete this form. A confirmation will be sent to you when your membership is approved and activated. In the meantime, if you have any questions, please do not hesitate to contact us at