IAM Club Membership Registration Form

Irish Association of Manitoba membership form
Our mission: To facilitate, aid and promote the integration of Irish people into the Canadian community and to conduct recreational, cultural and social sporting activities on behalf of the membership.
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred method of communication

PhoneEmailAny
Type of membership (memberships are valid Oct. 1 to Sept. 30):

Single: $25/yearFamily: $50/yearNew membershipRenewalHonourary
If you selected family membership, please provide the following information:
Name of Spouse

First NameLast Name
Name of dependant 1:

First NameLast Name
Date of birth of dependant 1:

MonthDayYear
Date
Name of dependant 2:

First NameLast Name
Date of birth of dependant 2:

MonthDayYear
Date
Name of dependant 3:

First NameLast Name
Date of birth of dependant 3:

MonthDayYear
Date
I understand that the Irish Association of Manitoba Inc. has the right to accept or refuse an application for membership.
Your support is crucial to our mission and we thank you for your membership. If you are able, consider making a small donation to the Irish Association of Manitoba which will contribute to our efforts of offering quality programs and events all year.

$25$50$75$100
Amount of your choosing:
Signature

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Date

MonthDayYear
Date
Payment

Membership payment can be made by:
- Cash
- Cheque
  - Made out to Irish Association of Manitoba (mailing address below)
- E-transfer to: info@irishassociation.ca
- Credit card (using the form on the IAM website)
Mailing address:

Irish Association of Manitoba
654 Erin Street
Winnipeg, MB R3G 2V9
Once you submit your application, we will contact you to complete your membership application.

Thank you!
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Irish Association of Manitoba membership form

Our mission: To facilitate, aid and promote the integration of Irish people into the Canadian community and to conduct recreational, cultural and social sporting activities on behalf of the membership.