CYMK Membership Registration Form 2020-2021
*For Provincial and National CYMK and USRL Executive Use
Name of Member *
Local CYMK Branch *
Local Executive Position (if applicable)
Clear selection
Provincial Executive Name and Position (if applicable)
Age *
Date of Birth:
MM
/
DD
/
YYYY
Email *
Phone Number
Address (including city and postal code):
Membership Fees *
Waiver: I allow my personal picture, if taken at a CYMK event, to be included on 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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