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DD MM YY

MEMBERSHIP APPLICATION

Canadian Snowbird Association

1-800-265-3200

www.snowbirds.org

180 LESMILL ROAD, TORONTO, ONTARIO, CANADA M3B 2T5

Source code:

E96

REV. 08/2013

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

www.snowbirds.org or

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

CSA

news

Sign up five new members and

become a Key Member of the CSA!

DD MM YY

Signature ________________________________________ Date _ ___________________________________

Membership Number (for renewing members)_ _____________________________Language English Français

Applicant’s Name___________________________________________________Date of Birth_______________

Spouse/Partner’s Name_______________________________________________Date of Birth_______________

Canadian Address___________________________________________________________________________

City_ ______________________________________ Province_______________Postal Code_ ______________

Telephone ( )_________________________________ Cell ( )_ _______________________________________

E-mail _ __________________________________________________________________________________

Winter Address_ ____________________________________________________________________________

City_ ______________________________________ State_ ________________ Zip Code_ ________________

Telephone ( )_________________________________ Referring Member Name or Number_ _________________

Payment

VISA MasterCard Cash Cheque

(Make payable to: Canadian Snowbird Association)

Credit Card # _ _______________________________________________ Expiry _ ______________

Membership

per household (maximum 2 people)

1 Year

$25

2 Year

$45

3 Year

$65

5 Year

$99

Lifetime

$325

Credit provided for any dues paid in the last 5 years; call to confirm savings.

Special Action Fund Donation

$20

$30

$50

$100

Other _____________________________

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 and are renewable every June 30.

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.

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.

Membership dues and fees are subject to change without notice.

CSA

Application

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