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.
Yes I agree/allow the ISCCA may send email to keep me informed about the organization and events notices.No I do not allow the ISCCA to send emails to me.
E-Mail Address*
example@example.com
Date

MonthDayYear
Date
New Membership ($5 Membership fee (Valid for June to May of next year)College of Monarch (can optionally pay $5 (Limited to E&E, P&P, D&D))Board of Directors (Only for current and continued positions)
PresidentVice PresidentSecretaryTreasurerDirector at Large
Membership Fee ($5) - Payment Collected by*
College of Monarchs Title (Latest Title):*
Reign (last reign)*
YesNo
College Donation Amount
College Donation
College Donation Collected by:
SIGN HERE - Typed name is required.*

First NameLast Name
Should be Empty:

Membership Form