Youth Membership Application- Embroiderer's Association of Canada

Embroiderers' Association of Canada Inc.

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Youth Membership Application

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Date: ____________________

Name:_____________________________ E-mail address:____________________________

Address: __________________________________________________________________

City:________________________ Prov/State:___ Postal/Zip Code:__________ Country:____________

Telephone number:(____)_____________ Fax number:(___)__________________

Birth Date: ___________________________

$15 Fee ($20 Canadian for International) Paid by:

__ Cheque __ Money Order (Payable to Embroiderers' Association of Canada)

__ Visa Number:__________________________________ Expiry Date:________________

Name on Card:________________________________ Signature:______________________

How did you hear about us?
___ Friend
___ Website
___ Other _______________________________________________________________

Please return this form and your fee to:

Linda Brenner
EAC Youth Embroiderers' Director
Unit 3, 7600 Gilbert Road
Richmond, BC V7C 3W2
_______________________________________________________________________________

For Official Use: Membership # _______________ Renewal Date: ___________

Chapter: _______________________________________________

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