SOUTH CHANNEL ASSOCIATION
Membership / Renewal Application Form
Jan. 1, 2005 to Dec. 31, 2005
Name New Member_____ Renewal _____
Home Address ___________________________________ City
Prov/State
Postal Code / Zip Code ____________________________ Cottage
Phone: Home Phone
Cottage Location
___________________________ E
Mail Address
__________________________________________________
The next directory lists our 2004
membership: Please list the information
you would like included in the 2005 South Channel Directory :
If no
information is provided, you will not appear in the directory : Past members may instruct us to repeat
2004 information
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South Channel Association Member |
Cottage Address/phone |
Adult Cottagers |
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 by February 28, 2005 to
: Steve Blundy, Membership
Chair
South Channel
Association
1261 White Oaks Blvd.,
Oakville,
ON
