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CFUW BELLEVILLE & DISTRICT MEMBERSHIP REGISTRATION FORM 2009-2010 |
Personal Data
Dr. ___ Mrs. ___ Ms. ___ Miss ___ None ___
Surname: ____________________ Maiden name (opt.): ________________
First Name: __________________
Address: ___________________________
City: __________________ Province: _________ Postal Code _________
Home Telephone No. _______________ Work Telephone No. _____________ Fax: __________________
E-mail address: ___________________________ (Important: Correspondence, including monthly newsletters, will be sent electronically to you)
1. University (or College) ______________ Qualification: _______________ Year: ______
2. University (or College) ______________ Qualification: _______________ Year: ______
Involvement
Are you willing to work on short -term projects? _____________________________________________
Are you willing to serve on your CFUW Executive Committee next year? __________________________
What skills and interests would you like to bring to the Club? ___________________________________
__________________________________________________________________________________
Membership Dues
| $75 if paid before October 31, 2008; otherwise $80 per annum | Fee Paid: ____________ |
Please remit a cheque payable to CFUW Belleville & District along with this completed form to:
Sandi Repic: 307 Frankford Road, R.R.1, Foxboro, ON, K0K 2B0
If you wish to make a donation to the Scholarship Fund at this time, you may also remit a cheque payable to CFUW Belleville & District Scholarship Trust Fund. $ ____________. Please note that a tax receipt will be received for this amount.
Interest Groups The following is a list of our Interest Groups. Please indicate which ones you are interested in joining.
| Book Exchange Bridge Canadian Literature Dinner Group Canadian Literature Lunch Group Contemporary Concerns Exploring Music Gourmet 1 Gourmet 2 |
Gourmet 3 Music Quilting/Scrapbooking Read the World Social Action WIT (Women's Investment Team) Walk and Talk Winetasting |
Status (Please check one)
Returning Member (member in previous years, but not 2007-2008)
New Member. How did you find us? Friend ___ Newspaper ___ Internet ___ Other ______________
Additional Information
Would you like to have a ride to General Meetings? Yes ___ No ___
Could you provide another member with a ride to the General Meetings? Yes ___ No___
Privacy: All information you provide on this form will be held in strictest confidence for Club use only.