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Membership Application Form

Please Note: Details that you enter here will be added to the Members Directory.

Principal Member:
Title	Mr Mrs Ms Miss Dr
Surname
Given Names
Home Town
Home Province/State
Address
Street Number
Street Name
Suburb
State	Victoria Australian Capital Territory New South Wales Nothern Territory Queensland South Australia Tasmania Western Australia Other
Postcode
Contact Details
Home Phone
Work Phone
Mobile Phone
Email Address
Use this Email Address for Club Correspondence?
Partner:
Name
Home Town
Home Province/State
Work Phone
Mobile Phone
Email Address
Children
Name	Place of Birth (Optional)	Birthday (Optional)

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Interests:

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Please choose one of the following conditions:

Born in Canada Canadian Citizen Married to a Canadian Child of a Canadian Served in the Canadian Defense Forces Lived in Canada at least three consecutive years -- still maintain ties there

If you chose the last option, please elaborate here:

Introduced to the club by: