SOUTH CHANNEL ASSOCIATION
Membership
/ Renewal Application Form
Jan. 1, 2007 to Dec. 31, 2007
Name New Member_____ Renewal _____
Home Address ___________________________________ City
Prov/State
Postal Code / Zip Code ____________________________ Cottage
Phone: Home Phone
Civic Address (Green
Sign) ___________________________
E Mail Address ________________________________________________
List the
information you would like included in the South Channel Directory
NOTE: Last year’s directory information
will be repeated unless otherwise indicated below
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Cottage Location / phone |
Adult Cottagers (SCA member and others who use cottage) |
Home Address/Phone |
Children/ Ages |
Fire Pump |
Other Information |
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INVOICE
Membership Fee ($63.00)
Enclosed $_________________
Additional Voluntary Contribution $_________________
Total $ _________________
(Please make cheque payable to South Channel Association)
Please Mail Form to : Steve Blundy, Membership Chair
South Channel
Association
1261 White Oaks Blvd.,
Oakville,
ON
