Canadian Club Membership Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Full Name/s: *

E.g. Mary Smith, John Smith

Work Phone:

Please include area code and person's name e.g 09 555-5555 - John Smith

Mobile Phone:

Please include person's name e.g. 021 777-8899 - Mary Smith

Home Phone: *

Please include area code e.g. 09-555-5555

Email Address (1): *

Please include person's name e.g. name@gmail.com - Mary Smith

Email Address (2):

Please include person's name e.g. name@gmail.com - John Smith

Membership Type

Please select one of the membership types below. We encourage everyone to please join the club as a paid member. Membership entitles you to be eligible for discounts to selected club events, supports the club’s hosting of events, enables the club to provide awesome prizes, maintain a website, and newsletters as all the support provided by the club committee for the club is purely on a volunteer basis.

Individual (Canadian, 19+ years): $12

Family (Canadian): $24

Associate Individual (non-Canadian, 19+ years): $18

Associate Family (non-Canadian): $30

Corporate Member: $36

Guest Only: $0 (full payment at events)

Home Town/s in Canada:

Please include person's name e.g. Vancouver, British Columbia - Mary Smith

Postal Address: *

Please include postal code e.g. 123 Any Street, Any Suburb, Any City, 1234

Children:

Please include First Name and Age e.g. Bobby Smith - 9 years

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.