Membership Application May 1, 2023 to April 30, 2024Membership Start Date: MM slash DD slash YYYY Consent I hereby apply for Membership and agree to comply with the By-Laws of the Club.Your Name(Required) First Last Your Address Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Your Email Address(Required) Email Address Confirm Email Address Contact PhoneHome PhoneBusiness PhoneCell PhonePreferred Phone to Contact(Required) Home Phone Business Phone Cell Phone Occupation Company Name & Position Payment Type(Required)Choose OneChequeE-TransferCredit CardPayment by ChequePlease mail your cheque payable to BPW Brampton to Pat Dowling, 333 Gooseberry Street, Orangeville, ON L9W 5B9Payment by E-TransferPlease send your E-Transfer to [email protected] PASSWORD: membershipMember Renewal: I will send payment of the current fee of $150.00. New Member: I will send payment of the current fee of $170.00 which includes $20.00 one time initiation fee. Student Member Renewal: I will send payment of the current fee of $115.00. New Student Member: I will send payment of the current fee of $135.00 which includes $20.00 one time initiation fee. Payment by Credit CardOur treasurer will get in touch with you for your credit card payment.Member Renewal: I will pay current fee of $160.00. New Member: I will pay current fee of $180.00 which includes $20.00 one time initiation fee. Student Member Renewal: I will pay current fee of $125.00. New Student Member: I will pay current fee of $145.00 which includes $20.00 one time initiation fee. Young BPW I am a Young BPW Member (35 or younger).Personal Information Consent I hereby give consent for BPW Brampton to use my personal information and/or use and distribute my image or voice in photographs or video for the sole purpose of providing benefits of membership (i.e. Newsletters, Annual Reports, Website as appropriate) within the different levels of the BPW organization (BPW Brampton, BPW Ontario, BPW Canada, BPW International). I further agree to protect members’ personal information from distribution, publication or any commercial use whatsoever.Personal Information Distributed to Members I hereby give consent for my personal information to be distributed to other members on the Brampton Membership Directory as described immediately above.Current Date: MM slash DD slash YYYY Signature
