CYMK Membership Registration Form 2019-2020
*For Provincial and National Executive Use
Name of Member *
Your answer
Local CYMK Branch *
Local Executive Position (if applicable)
Provincial Executive Name and Position (if applicable)
Your answer
Address (including city and postal code):
Your answer
Age *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Email Address *
Your answer
Phone Number
Your answer
Membership Fees *
Waiver: I allow my personal picture, if taken at a CYMK event, to be included in the Provincial and National Facebook media sites, on the CYMK website, www.cymk.ca; and any additional Provincial and Executive newsletters or online social media accounts. *
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