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42
Membership Application
Signature
_______________________________________________________
Date
_______________________________
Language Preference
English
Français
Lifetime Regular Membership
(Canadian principal residence)
$325 CAD
per household
(max. 2 people)
Lifetime Associate Membership
(U.S. or overseas principal residence)
$325 USD
per household
(max. 2 people)
Annual Regular Membership
(Canadian principal residence)
Per household
(max. 2 people)
– renewable every June 30
$25 CAD
One Year
$45 CAD
Two Years
$65 CAD
Three Years
$99 CAD
Five Years
Annual Associate Membership
(U.S. or overseas principal residence)
Per household
(max. 2 people)
– renewable every June 30
$25 USD
One Year
$45 USD
Two Years
$65 USD
Three Years
$99 USD
Five Years
Donation
Special Action Fund
$20
$30
$50
Other_ ____________
Please Duplicate as needed
Canadian Snowbird Association
1-800-265-3200
180 Lesmill Road, Toronto, Ontario, Canada M3B 2T5
Source code:
E83
I/we hereby apply for membership in the Canadian Snowbird Association
(CSA) and, if accepted, acknowledge and/or agree as follows:
1) Membership dues are non-refundable.
2) Information contained in this application may be used by the association
for various purposes in accordance with privacy legislation including, but
not limited to the following:
a) Marketing purposes or research.
b) Association-approved third parties as may be necessary.
3) The association will make reasonable efforts to ensure that we are
advised of the purposes for which the information may be used.
4) The letters patent, by-laws, rules, regulations and policies of the
association are binding.
Membership dues and fees are subject to change without notice.
q
Canada’s Privacy Laws – By ticking this box, I do not consent to the
disclosure of the above personal information. I understand that this decline
of consent does not, in any way, prohibit the association from disclosing any
necessary information as may be legally required under provincial, federal,
or other legislation, or as may otherwise be required by law. I understand
that by refusing my consent I may be limiting the full value, benefit and
effect of participating in this membership. I further understand that if the
full benefit of participating in this membership is reduced, I am not entitled
to a reduction in the membership dues/fees as listed above.
The Canadian Snowbird Association is in compliance with the
Personal
Information Protection and Electronic Documents Act
(PIPEDA) of the
Government of Canada.
To exclude your subscription to the
CSANews magazine
, deduct $9.95 from
the annual dues rate.
REV. 04/2007
CSA
application
Membership Number
(for renewing members)
_ _______________________________
Applicant’s Name__________________________________________________ Date of Birth_ _______________
Spouse/Partner’s Name_ _____________________________________________ Date of Birth_ _______________
Principal (Main Home) Address_________________________________________________________________
City_ _____________________________________ Province_______________ Postal Code_________________
Telephone ( )____________________________ Cell ( )____________________________________
E-mail_ _______________________________________________________________________________
Secondary (Winter Home) Address_ ______________________________________________________________
City_ _____________________________________ State_ ________________ Zip Code___________________
Telephone ( )____________________________
Referring Member Name or Number
_ __________________
Payment:
q
Cheque
q
VISA
q
MasterCard
q
Cash
(Please make cheque payable to: Canadian Snowbird Association)
Credit Card #_ ___________________________________________________ Expiry_ ___________________
Let us grow together
The CSA is constantly looking for new members, just like you. Sign up five new
members and get your next annual membership FREE. Download five applications
from our website at
photocopy the application below. Have
five of your travelling friends become new and valued members of your association.
Your efforts will be honoured with:
Free Annual Membership
Special Key Member Pin
Your name published in
CSANews
Sign up five new members and
become a Key Member of the CSA!