SOUTH CHANNEL ASSOCIATION                                              

Membership / Renewal Application Form                                          

 

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

     
    Cottage Location / phone    		  
    Adult Cottagers

    (SCA member and others who use cottage)

    		  
    Home Address/Phone    		  
    Children/

    Ages

    		  
    Fire Pump    		  
    Other Information
     
     
     
     
     
     
     
         		          
     
         		      
         		  
     
      .      

INVOICE

 

Membership Fee ($63.00) Enclosed    $_________________      

Additional Voluntary Contribution    $_________________ 

                                    Total  $ _________________       Payment due by April 15, 2008 

(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

                               L6H 2N6