Chimo Club Toronto Membership Application

MEMBERSHIP APPLICATIONS

To apply for membership, please print out and complete the following application form and mail or fax the completed form to the address at the bottom of the page.

Want to know more? Join us as a Guest at our next meeting.

MAILING / ROSTER INFORMATION

Full Name:

____________________________________

Business Affiliation:

____________________________________

Position:

____________________________________

# of Years in the Industry:

____________________________________

Business Address:

____________________________________

City:

____________________________________

Province:

____________________________________

Postal Code:

____________________________________

Bus. Telephone:

____________________________________

Fax:

____________________________________

E-Mail:

____________________________________

ICS or Watts?

____________________________________

BUSINESS CATEGORY (Please check one)

-A- Airline Industry -B- Bus or Rail -C- Car Rental -E- Educator

-H- Hotel -O- Tour Operator -R- Related Industry -S- Ship Line

-T- Travel Agency -V- Visitor, Convention or Tourist Board

-X- Associate Member Other (specify)_________________________________

PERSONAL INFORMATION

Home Address:

____________________________________

City:

____________________________________

Province

____________________________________

Postal Code:

____________________________________

Telephone:

____________________________________

Fax:

____________________________________

Do you wish to participate in committee work?

Yes No

If yes, please indicate the area in which

you would be interested:

Membership Program Environment

Fund-Raising Attendance

Fellowship Others:_________________________

NAME BADGE FORMAT:

Name:

____________________________________

Company:

____________________________________

Signature:

____________________________________

Date:

____________________________________

Cheque enclosed to the amount of $160.00
($110.00 annual fee + $50.00 initiation fee)

Receipt Requested?

Effective June 1 midseason rates apply $105.00
($55.00 fee + $50.00 initiation fee)

Please print and forward the completed form to:

DEBORAH DAVY
1st Vice President, Membership
The Delawana Inn Resort
5300 Yonge Street, Suite 205
Toronto, Ontario, M2N 5R2

Telephone: 416-228-1200 Ex 265 Fax: 416-912-1912

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FOR CLUB USE ONLY

Referred By: ____________________________________
(members name)

Board Approval Date: ____________________________

Membership Date: _______________________________