Orchestra X Membership Form 2014-2015

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2014-15 MEMBERSHIP
Please clearly fill in ALL the following information even if you are a returning member
NAME_____________________________________________________________________________
_______
ADDRESS__________________________________________________________________________
_______
CITY____________________________________ POSTAL CODE
________________________________
Home Telephone #: _________________________ Work Telephone #: _________________________
Cell #: ____________________ E-MAIL
________________________________________________
INSTRUMENT____________________________________________________________
MEMBERSHIP CATEGORY (SELECT ONE)



Full Membership
Full-time Student Membership
$140.00
$50.00
(Membership fee is tax deductible.)
Auxiliary Membership
 Tax Deductible Donation
$20 each Concert - # of concerts: _______
$____________ Please consider helping Orchestra X!
TOTAL AMOUNT ENCLOSED (select one): $______________
 Cheque
 Cash

#_______________________________________ Expiry Date ____________________
Name on Card ___________________________ Signature ____________________________
I have read and agree to abide by the Membership Policies of Orchestra X.
_________________________________ _______________________________
Signature of Member and/or Parent/Guardian
Date
Planned Absences – Please indicate any dates where you are not able to participate
in a scheduled Orchestra X rehearsal or concert:
___________________________________________________________________________________________________
All forms and payment due by August 29th, 2014
If membership forms and payment are not received by
this date your membership may be reviewed.
_____________________________________________________________________________________
XYZ address. X, ON, HOH OHO
www.orchestraX.ca
[email protected]
800-555-1212
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