Dutch Canadian Club: Membership Application

Membership Application/Renewal Form

As a member of the Dutch Canadian Club you are entitled to the following benefits:

Get back to your Dutch roots, connect with your ancestry, or just socialize with the great people at the club.
Only members can book the Flying Dutchman Club Room for family functions like birthdays, anniversaries, etc., for a flat rate of $125.00.
a discount of 15% on rental fees for the other rooms in the facility.
a subscription to the Dutch Touch monthly newsletter.

THIS APPLICATION MADE THIS DAY OF 20

BETWEEN: THE DUTCH CANADIAN CLUB (EDMONTON)
-AND-

Name:

Email Address:

Address:

Postal Code:

Telephone #:

Alternate #:

Fax #:

Choose the type of membership you would like to purchase:

Family member

$50.00

Senior Family member

$40.00

Single member

$30.00

Senior Single member

$25.00

Student member

$15.00

Upon submitting this application, a comfirmation email will be sent to both yourself at the email address provided as well as the membership chairman. Your membership will remain tentative until your membership fees are paid.

Name:
Email Address:
Address:
Postal Code:
Telephone #:
Alternate #:
Fax #:

Family member	$50.00
Senior Family member	$40.00
Single member	$30.00
Senior Single member	$25.00
Student member	$15.00