7250 Ashburn Street, Vancouver, B.C., V5S 2K7 Tel: 604-773-1007 Email: [email protected]

Application for Membership (Please mail completed form to the address above)

CONTACT DETAILS

APPLICANT

PARTNER / SPOUSE

Name: Country of Birth: Email Address: Company Name : (for corporate members only) Home Phone: Cell Phone: Home Address: City: Postal Code: Special Interests/Hobbies: No. of Children (under 18 years old): Annual Membership Fees Family Member - $20.00 (family with accompanying child(ren) below the age of 18) Individual Member - $10.00 (individuals aged 18 years and above) Life Member - $200.00 one-time payment (individual or couple) Corporate Member (for Companies & All Legal Entities) - $100.00 Student Member - $5.00 (student of any age) Cash/cheque made payable to MABC Would you be interested in volunteering in MABC: Board Member:

Yes

No

Committee member:

Applicant’s signature: ___________________________

Yes

No

Date: ________________________________________

(Please note that all MABC communications will be via email only at this time. If you do not have an email address, please arrange to set one up. Periodical newsletter will be published and distributed via email.) MABC reserves the right to take photos of participants at our events/meetings and to use these images solely for the purposes of newsletters and our website.

Proposed By:

Seconded By:

Remarks by MABC: Membership No.: Email Confirmation Sent:

Expiry Date: Yes

No