Membership Application

Winter/Spring 2009

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Affiliated with: Thompson Rivers University

 

MEMBERSHIP APPLICATION FORM

 

The membership fee includes conditional access to the Thompson Rivers University library, bookstore and Elder College activities. (Individual course fees are expected to be modest and will be set on a course to course basis, essentially to cover direct administration costs only.)

 

THE FEE FOR THE __________ACADEMIC YEAR IS $10.00.

 

Date                     ______________________

Name                   _____________________________________________________________________

Mailing Address   _____________________________________________________________________

City                      _____________________________________    Postal Code____________________

New Member       ____________   Membership Renewal _______________

Telephone             __________________             E-Mail ______________________________________

Fax                       ____________________

Birthdate:     Y_______M_______D______                                      Female_______Male_______

 

METHOD OF PAYMENT

 

___ Cheque made payable to the Cariboo Chilcotin Elder College (please do not post-date cheques).

___Cash

 

THIS FORM MAY BE MAILED TO THE ADDRESS BELOW.

Are you interested in becoming an Elder College Volunteer?   Yes ___ No ___

Please indicate in which areas you would like to volunteer (i.e. committee member, instructor, course assistant, etc.)

____________________________________________________________________________________
____________________________________________________________________________________

Other Comments ____________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

 

Photographs may be taken and used in Publication

 

 

 

Mailing Address:          Cariboo Chilcotin Elder College,

Thompson Rivers University,

1250 Western Avenue,

Williams Lake, BC, V2G 1H7

Telephone:  (250) 392-8180

Website: http://www.cceldercollege.com

Email: secretary@cceldercollege.com

 

 FOR OFFICE USE ONLY:

 

Membership Card Given          ___

Newsletter Given                     ___

Data                                        ___

 

Place completed form in

Elder College File.

 

 

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