Reign 49 ISCCA Membership Application

Membership Form
Application for Membership Valid for Reign

- Expires upon AGM date (Third Sunday of each June)
Name
Alternate/Stage Name(s)
Street Address
City
Province
Postal Code
Phone Number
Format: (000) 000-0000.
E-Mail Consent
E-Mail Address
example@example.com
Date

MonthDayYear
Date
Membership Type
Board Position (Only for current and continued positions)
Membership Fee ($5) - Payment Collected by
College of Monarchs Title (Latest Title):
Reign (last reign)
College Donation (Recommend donation for Bursary fund)
College Donation Amount
College Donation
College Donation Collected by:
SIGN HERE - Typed name is required.

First NameLast Name
Should be Empty:

Membership Form