Membership / Renewal Form

Membership Rules:

All members will be treated with dignity, respect, and fairness by all other members and guests.
Members must be 50+ years within membership calendar year, and from Laurentian Valley and surrounding area.
Members will accept the group's constitution, regulations, and codes of practice.
Members have voting rights at general meetings.

Annual membership/waiver form and fee of $25 are due on September 1st and are not prorated. Fees must be paid to attend/participate in activities unless otherwise stated.

Payment Methods:

Preferred method is to e-transfer the fee to fitandfeisty50@gmail.com. Indicate membership fees and additional names (if paying for more than one person) on the message line of the e-transfer payment.
Cash/cheque may be placed in the LV50+ Fit & Feisty dropbox in the lobby of the Laurentian Valley Township Office, Monday to Friday during regular office hours of 8:30 am to 4:00 pm, or dropped in the secure outside mail slot after hours. Place payment in an envelope and clearly mark your name, (names), indicate it is for membership fees, and the amount.
Cheque may be mailed to 1 Henan Road, Pembroke, ON K8A 6W8
Place your payment in an envelope clearly marked with your name or names, membership fees, and the amount. Fees will be taken at Coffee Connect on Wednesdays from 9:30 am - 10:00 am prior to the start of Coffee Connect.

***PLEASE NOTE***

When a payment is made by e-transfer, the funds are deposited by auto-deposit into the Fit and Feisty account. If matching funds for membership are not received, we will contact you.
Your confirmation from your bank serves as your personal record of the email transfer transaction. LV 50+ Fit and Feisty confirming receipt of funds a second time is very time-consuming.

Are you a new member or renewing your membership?*

Full Name - Last Name First Name*

**NOTE** Only ONE entry per registrant. Simply refresh form upon submission if registering more than one person.

Enter LAST name first followed by FIRST name. e.g: Doe Jane

Address*

Street Address

Street Address Line 2

City

Postal Code

Email

example@example.com

Phone Number*

Please enter your preferred phone number

Emergency Contact*

Emergency Contact Phone Number*

Please enter your preferred phone number

Click to certify that you are 50 years of age or older*

Yes I am 50+

Are you interested in volunteering for the group?

LV50+ Fit and Feisty is an organization that benefits from financial grants. Grants often require demographic information of the applicant population. As such, we are now gathering some general demographic information to assist in fully understanding the composition of our group, for activity/event purposes, and to also maximize the grants that we can qualify for.

What is your birth year?*

What is your gender*

What is your native language?*

EnglishFrenchOther

Cultural/Ethnic Background*

example: Indigenous, French, etc.

Are you a Military Veteran?*

YesNo

What is your current work status?*

RetiredEmployed FulltimeEmployed Part time

Do you require any support or accommodations? We are collecting accommodation responses for informational purposes, and may not be able to meet all needs.*

NoYes

If yes, please specify*

NEW MEMBERSHIP or RENEWAL

Waiver ("Release Agreement")