APPLICATION FOR MEMBERSHIP (RENEWAL) IN “THE CANADIAN MASTERS CROSS-COUNTRY SKI ASSOCIATION”

membership #(RENEWAL)___________  (NEW MEMBER)__________

NAME: (first)___________________  (family)____________________

BIRTHDAY:______________       M / F ____      
         dd    mm    yy

ADDRESS:________________________________________

CITY:   ___________________    PROV ___________

CODE _____________

TELEPHONE:  ____   _____-__________         

E-MAIL ______________________________________

SIGNATURE:______________________    DATE: ____________

NEWSLETTER (ENGLISH) ___ (FRENCH) _____

***IF LIVING OUTSIDE CANADA GIVE PROVINCE OF LAST RESIDENCE:________________

                                          FEES :  $__20.00_________

                  SPECIAL DONATIONS (OPTIONAL) :  $___________
                                                                           
                                         TOTAL :  $___________

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