CFUW Saanich Peninsula Membership Form

First Name *

Last Name *

Address *

Address Line 1

City

State / Province / Region

Zip / Postal Code

Preferred Telephone Number *

Email *

Emergency Contact Name *

Emergency Contact Telephone Number *

To comply with the Personal Information Protection and Electronic Documents Act (PIPEDA), we need permission to include pictures of you on the CFUW Saanich Peninsula website, in social media, newsletters and other marketing activities. Please check Yes or No if we can use photographs of you, and then sign and date below.

Approval to Use Photographs *

Signature *

Date *

Members participating in all events and activities sponsored and organized by CFUW Saanich Peninsula do so at their own risk and are responsible for their own safety. Please sign and date below your acceptance of this disclaimer.

Signature *

Date *

Membership Status (Please Check) *

New
Renewal
Dual Club

If Dual, what is your home Club?

Annual Member Dues *

Full Member – $120
Dual Member – $65
Student – $60

Payment Type *

Cheque
E-Transfer

CFUW Saanich Peninsula Membership Form

To Pay by Cheque

To Pay by Interac E-Transfer