ISC Membership Form

Application Date

Existing member, please date the renewal box below

Membership Renewal

1st time member, please leave it blank

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Cellular Number*

Area CodePhone Number

Home Number*

Area CodePhone Number

Occupation*

Be general

Age Group*

Emergency Contact*

Mandatory Information

Emergency Contact Phone Number*

Area CodePhone Number

Where did you hear about us?*

Friend (put her name in the box below)Social MediaEvents

Which friend introduced you to ISC?

What are you looking for by joining ISC?

What areas are you interested to gain more knowledge in?

Topics or skills that I would like to present in future workshops:

Be creative here, list all the skills/knowledge that you can share with others

Are you interested in any managerial position of ISC?*

YesNo

If Yes, in what areas?

Please be specific

Core membership fee covering 4 events, all social events will be PAYG (Pay as you go)

New member $100Membership renewal $60

How have you paid your annual membership fee?*

CashCheque written to Insight Society CanadaEmail transfer to insightsocietycanada@gmail.com

Please tick all the perspective boxes*

I have read, fully understand, and agree to comply with all the terms and conditions stipulated in the ISC By-law (https://insightsocietyotta.wixsite.com/insight/by-law).In consideration of signing this membership application form, I agree to RELEASE, HOLD HARMLESS AND INDEMNIFY the Insight Society Canada, or any of its officers, directors, members from any and all liability, claims and causes of action arising out of or in any way connected with my participation in any activities offered by Insight Society Canada. I personally assume all risks in connection with these activities. The terms of this agreement shall serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family.I also agree to release the use of my name, address, phone number, and email for the membership directory and ISC events (only for internal purposes, no sharing of information to any third party without prior consent from the member), and confirm that all the information I have provided is accurate.During future ISC activities, photos or videos may be taken. By clicking this box, you are giving us consent for taking pictures or videos of you. I consent that these images or films may be used by Insight Society Canada in printed and online publicity, on social media, in newspapers and magazines, or in any other ways that further the aims of this organization.

Signature*

Note: Receipt can be issued upon requst

InSight Society Canada Membership Application/Renewal Form

QUESTIONNAIRE

Acknowledgement*