Membership Registration Form for The Danish Club of Ottawa

Membership Registration Form

Please print this page and return the completed form together with your payment to:

The Danish Club of Ottawa
Membership Secretary
P.O. Box 55032
240 Sparks Street
Ottawa, Ontario
K1P 1A1

Membership is valid from January 1 to December 31, 2008
Is this a:

Renewal of Membership New Membership

Name

_______________________

Name of Spouse

_______________________

Mailing Address

_______________________

_______________________

_______________________

City

_______________________

Province

_______________________

Postal Code

_______________________

Home Phone

(___)__________

Work Phone

(___)__________

Email Address

_______________________

Yes, I would like to receive Viking News electronically instead of a
paper copy.

Full Name: If this is a new membership, please indicate the full name of each family member to be included as a member of The Danish Club of Ottawa.

Date of Birth/Wedding (optional): We like to share and announce children's birthdays (up to the 14th), adult round birthdays and wedding anniversaries in the Viking News. If you would like to be included please provide the dates below.

"Volunteer" is there so that you can indicate your interest in helping out with one or more events. If yes, please provide the days of the week that you are available and/or specific events that you would like to volunteer for.

Full Name	Date of Birth dd/mm/yyyy	Wedding dd/mm/yyyy	Volunteer?
			Yes
			Yes
			Yes
			Yes
			Yes
			Yes
			Yes
			Yes
			Yes
			Yes

Membership Fees

Family

$25.00 (2 adults and children under 18)

Single

$15.00 (1 adult and children under 18)

Senior Couple

$17.00 (60+)

Senior Single

$10.00 (60+)

TOTAL ENCLOSED

$ __________

Please make cheque payable to: The Danish Club of Ottawa