Membership Application Form

Your name

Known as

Birth (month and day)

Spouse or Partner name

Address (please include Street number, Apartment or Suite number)

City, Town

Postal Code

Phone (please include area code)

Your email (for executive committee use only)

Former Vocation or Field of Interest

Emergency Contact Name

Emergency Contact Phone (please include area code)

Emergency Contact Relationship to member SpouseSonDaughterCousinOther

The annual membership fee is $60. There is a one-time fee of $20 for your name badge. Membership renewal is September 1 (Our fiscal year is Sept. 1st to Aug. 31st). If joining after Feb. 1 the annual membership fee will be reduced to $30 for that year. Cheques can be made payable to Probus Club of Aurora. Please mail the completed form together with your payment to P.O. Box 28504 Unit 151-14800 Yonge ST., Aurora, ON L4G 6S6. If preferred, an e-transfer can be directed to our Treasurer, Marie Wallace at emmw1953@gmail.com.

“Matters concerning Probus” are: organizing club activities, phoning or emailing reminders of upcoming meetings or special events, dining out clubs, and the like, as well as facilitating social contact among the members, which is one of the aims of the club. Please tick your response to the following questions:

1. I give my consent to include my name, address and telephone number on the Membership List which will be distributed only to the members of the Probus Club of Aurora. yesno

2. I give my consent to include my name and photograph in the Probus Newsletter. yesno

3. The continued success of our club is dependent on its valued members and the many volunteers that are needed. Would you like to be more involved in our club activities by becoming a Volunteer? yes

Applicant Signature

Date

Δ