Membership Application
Formulaire d'Adhésion
Please enter the information below and submit. Send your cheque to
Time Out / Temps Libre, P.O. Box 1087 Station "B", Ottawa, Ontario K1P 5R1
.
Or print and mail this form with your cheque. [
$20
personne seul/single,
$30
famille/family]
Membership Type:
Type d'Adhésion:
New/Nouvelle
Renewal/Renouvellement
Name:
Nom:
Address:
Addresse:
Birthdate:
Date de Naissance:
Home Phone:
Télé Domicile:
Work Phone:
Télé Bureau:
Email:
Courriel:
Please enter any activities which you are interested in obtaining information or any other comments your may have:
Veuillez inscrire les activités dont vous désirez obtenir de l'information ou tout autre commentaire:
_____________________________________
Signature
