Club Membership Registration Form

MEMBERSHIP APPLICATION FORM

Complete the form below to sign up for our membership service.
New ApplicantRenewal
Name*

First NameLast Name
Phone Number:*

Area CodePhone Number
E-mail*
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Canadian Residential Status*
Membership type*
*Life Membership Family includes couples with 2 children under the age of 12 years old
Occupation
Special skill and interest
Where did you hear about us?

A Friend or colleaugeGoogleBlog PostNews ArticleOther
Your board member of referral/recommendation*
Declaration by applicant
I hereby affirm by signing this Membership Application Form that the information provided is true and correct.
I agree to abide by the Constitution and Bylaws of the Association.
Signature*

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Once you submit your application, it will be subject to be approved by the board of BC Cultural Diversity Association. We will contact you shortly to complete your membership application.

Thank you!
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MEMBERSHIP APPLICATION FORM