Heritage Club

est. 1989   |   People helping people

Membership application


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MEMBERSHIP APPLICATION
An annual membership fee will be assessed by the local chapter
Surname:
Given Name:
Init.:
Gender:
M F
Name Of Spouse:
Home Address:
City:
Province:
Postal Code:
Status:
Language Preference:
Telephone NO.:
Work NO.:
Which Chapter Do You Wish To Join?
CPC Start Date:
Email:
Total Years Of Service/Retirement date
My interests are:
Group Travel / Tours
Recreational Activities – golf, bowling
Cultural – theatre, concerts
Volunteering (santa letters, etc.)
Social activities – lunches, dinners, dances
Other: