Membership Form

Name:______________________________________________________________

Address:____________________________________________________________

City/Town:_________________________ Postal Code:_____________________

Telephone Number:__________________

Email Address:_____________________ Website:_________________________

[ ] Yes! I would like more information on volunteering.

Membership allows the corporation to apply for grants, and a large membership increases the eligibility for them.

I enclosed my yearly membership of: [ ] $25 Full [ ] $40 Family [ ] $15 Associate

I also enclose my voluntary payment for the bereavement fund. This fund is used to make a memorial donation to a charity of the member's choice when a close family member passes away. : [ ] $5

Payment details: [ ] Cheque (payable to Burlington Footnotes) [ ] Cash

Please forward this completed form with payment to:

Burlington Footnotes
c/o Doreen Stedman
Apt 1001, 770 Hager Ave.
Burlington, ON L7S 1X1

For more information contact:

Tel: 905.632-2215
Email: dstedman31@cogeco.ca

Full Membership Benefits

Voting privileges at general meetings
Annual news letter
Opportunity to serve on the board
Notification for upcoming events, courses, auditions calls
Bylaws and Financial Reports available prior to AGM
Opportunity to participate in social events
May receive funding assistance from grant money.

Associate Membership Benefits

Attend general meeting - no voting privileges
Opportunity to participate in social events
Annual News Letter
Be notified of upcoming events,courses auditions

Family Membership (spouse/partner/family member living at same address) Benefits

Same as full membership
Discounted Rate

WAIVER: I, the undersigned, personally and on behalf of my heirs, executors, administrators and assigns, hereby release and forever discharge the following:

Burlington Footnotes Senior Performing Troupe Inc.
All sponsors, organizers and volunteers of said organizations, their respective officers, directors, agents, representatives or successors, from any and all claims or demands that I have or my heirs, executors, administrators, assigns or any third party may have for personal injuries and property damage of any nature whatsoever, arising by reason of my participation or volunteering at any level of the organization's programs and productions.

I have read the above Statement, understood it and my signature confirms its acceptance. I attest and verify that I have full knowledge of the risks involved in my participation and I am physically fit and able to participate in said programs and productions.

Signature: __________________________________ Date: ____________________

Witness Signature _______________________

Medical Information (i.e. allergies, medications, conditions, etc.): ________________ _____________________________________________________________________

Please Note:
Burlington Footnotes respects your privacy.
We protect your personal information and
adhere to relevant privacy legislation.
We do not rent, sell or trade our mailing list.
We will use this information to keep
you informed of Burlington Footnotes' activities.
If you wish to be removed from the contact list,
call or email : Tel: 905.632.-2215
Email: dstedman31@cogeco.ca