Contact First Name Contact Last Name Title/Position Contact's Phone Number E-mail Address Username Password Confirm PasswordBusiness InformationBusiness Operating Name Business Legal Name Business TypeGas StationConvenience Store with Fuel SalesFuel DistributorIndependent RetailerCorporate StoreFranchiseeBusiness Owner Name Store Phone Number Website URL Street Address Number of Locations Operated Please complete the names and address of your other locations below:Number of Employees Wholesaler Store Brand Are you on Rack or Regulated Margin?RackRegulated MarginWould you like to participate in our quick weekly survey calls for Service Nova Scotia?YesNoWhy Do You Want to Join the RGDA?I confirm that the information provided is accurate and complete, agree to abide by the RGDA Code of Conduct and Membership Terms, and understand that submission of this form does not guarantee membership approval. Only fill in if you are not human Login