CANADIAN BHUTANESE SOCIETY

CANADIAN BHUTANESE SOCIETY
Cultural Preservation Through Community Participation
Membership Registration / Renewal Application Form
Please complete all required sections of this membership form. Canadian Bhutanese Society (CBS) will keep your information confidential and use it only for membership records, communication, community programs, and related CBS activities.

By signing this form, I agree to follow the constitution, rules, regulations, and decisions of CBS and to support and participate in its programs and activities.
1. Personal Details
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Membership Type
Address Details

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
2. Membership Request
Membership Request Type
E-mail cbslethbridge@gmail.com
Phone (587) 425 2188
www.cbsalberta.org

4. Additional Family Members

5. Declaration
I confirm that the information provided in this form is true and correct to the best of my knowledge.

5. Declaration I confirm that the information provided in this form is true and correct to the best of my knowledge.

Rows	Applicant Name	Signature	Date
1