Signaller Club of Canada Application Form

Post Office Box 1983, Kingston, Ontario, Canada K7L 5J8
E-MAIL the-sigs-club at symbol the-sigs-club.ca
(for email: replace "at symbol" with @ and remove any spaces)
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MEMBER'S INFORMATION SHEET
Date:__________                                  Sponsor:_____________________
(if any)

______________________________________________________________________________
(Surname)                   (Given Names)                           (Nickname)

______________________________________________________________________________
(Permanent address)                                              (Postal Code)

(____ )__________________(____)_______________________________________________
(Phone - home)           (Phone - FAX)                         (Spouse's name)

______________________________________________________________________________
(E-Mail address)                    (if licensed Ham Op enter call sign above)

______________________________________________________________________________
(dates of military service)

______________________________________________________________________________
(Medals & Decorations)

______________________________________________________________________________
(Other useful information) (e.g. Units served in, etc)
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Instructions:

1. After completing the above, tick your fee option in the appropriate box
below, and return this entire page with your fee:
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[    ] Option 1.   Annual Membership:
                    One-time enrolment fee:               $10.00
                    Annual Dues:                           15.00
                        Cheque/Money Order/Bank Draft:    $25.00 enclosed
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[    ] Option 2.   Life Membership:
                    One-time enrolment fee:          $ 10.00
                    One-time dues payment:            100.00
                    Cheque/Money Order/Bank Draft:   $110.00 enclosed
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2. Please make your Cheque/M.O./Bank Draft payable in Canadian funds to
"The Signallers Club of Canada" and send it with this form to the above address.
For persons with a Canadian bank account, a CDN cheque is okay; ALL OTHERS MUST
SEND A MONEY ORDER OR BANK DRAFT PAYABLE IN CANADIAN FUNDS.
DO NOT SEND CASH.
Thanks.

16 May 2002