Add a Service Provider

Service Provider

Account Settings

User Information

Username *

This will be your username to login to make changes to your provider profile.

Email *

This will be your account email address used for communications and forgotten password resets.

Re-enter Email *

Please re-enter your email address

Password *

Re-enter Password *

Contact Information

Title *

First Name *

Last Name *

Job Title

Provider Privacy Settings

I wish to keep my physical address be kept confidential *

Yes

I agree to hear from NEDIC about my service provider listing *

Yes

This is a mandatory requirement of joining the service provider directory.

I want to join NEDIC's mailing list *

Yes

Organization Information

Organization Name *

Organization Email

Department

Address Line 1 *

Address Line 2

City *

Province

Postal Code *

Phone *

Toll Free

Fax

Website

Math question * 4 + 2 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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