Membership APPLICATION FORM (from Website)
(Please print this Form. You can  either mail it to the address shown below or bring it with you to the Centre)

Date:   __________________________

Name:  __________________________________

Address:  __________________________________________________

City: ________________________ Prov./State: _______  Postal/Zip Code: _______________

Telephone: ___________________                   E-mail: _______________________________

Year of Birth: _________       Occupation:   ___________________________

How did you learn about our Centre?:

       Newspaper __     Public Event __     Internet __     Other __  (Specify Below)

_______________________________________________________________________________

Are you willing to volunteer?:   Yes      No     (Please circle one)

What do you hope to gain from your membership in the RASC ?:

_____________________________________________________________________

_______________________________________________________________________________


Regular membership (age 21 and over)
     (includes all Centre services PLUS all Society publications)                              $64.00

Youth membership (age 16 to 20)
     (includes all Centre services PLUS all Society publications)                              $41.50

                                                                             TOTAL:      $  _____.___

Please make your cheque or money order payable to :

Montreal Centre - RASC
P O Box 1752, Station B
Montréal, QC  H3B 3L3    Canada
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