CDMC Membership Registration Form (2020)

CDMC Membership Registration Form
Member Information
Name:*

First NameLast Name
Phone Number:*

Area Code Phone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:

MonthDayYear
Enter your Email address in the box below. Then click "Verify Email". You will receive an Email with a code to copy and paste into a new box that will be displayed. Finish by clicking "Confirm Code". You must complete this verification process in order to Preview and Submit your form.
Email address:*
Emergency Contact Information

Please enter your Emergency Contact Person's information below:
Contact Name:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Consent Options

Please choose one.
Do you agree to have your Member Name and/or Contact Info posted on the CDMC Website, for Member Access only?*

Yes: Name, Email, and PhoneYes: Name and Email onlyYes: Name and Phone onlyYes: Name onlyNO: Please do not include my info on the member access only Member List. (I understand that by selecting this option, other members including trip leaders will only be able to contact me via Meetup)
Personal Insurance

Please verify that you have read and understand the following statement:
By checking this box I understand that I am responsible for carrying the necessary medical, travel, and vehicle insurance when participating in any club trip or event.*

YES, I have read and understand my responsibility to carry personal insurance.
Membership Dues

Select Membership and Payment Type
Payment Options:*
prevnext( X )
Adult Membership - Paypal$42.00CAD

Associate FMCBC Membership - Paypal$18.00CAD

Comox Valley Ground Search and Rescue Donation - Paypal (we hope you will consider supporting the SAR volunteers and help them continue to have the tools and education necessary to support public need)$1.00CAD

Donation multiplier $1.00 x

Membership and/or SAR Donation by Interac E-TRANSFER: Please send separately to cdmchiking@gmail.com (please use security answer: comoxhiking) after submitting form: $42.00 + SAR donation$ FreeCAD

Total $0.00CAD
Enter Captcha*
You must Preview your form first to ensure all required fields are properly filled. Once you are satisfied with your form, click the Submit Registration Form button.

Once you have submitted your Membership Form and CDMC Waiver, please request to join the Comox District Mountaineering Club Meetup group on Meetup to access the group's hike and event schedule.
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CDMC Membership Registration Form

Member Information

Emergency Contact Information

Consent Options

Personal Insurance

Membership Dues