Membership Application / Mitgliedschaftsantrag
Mr. / Herr
Mrs. / Frau
Miss / Frl. _________________________________________________________
Hereby make application for Membership to: / beantrage hiermit die Mitgliedschaft im:
The Concordia Club, Kitchener, Ontario, and if accepted I agree to conform to the Rules and Regulatioins according to their Bylaws, as long as I remain a member / Concordia Club, Kitchener, Ontario, und falls angenommen unterstelle ich mich den Regeln und Satzungen, solange ich ein Mitglied bin.
Signature: / Unterschrift: _______________________________________________
Address
Street: / Strasse: ____________________________________________________
City / Stadt: _______________________________________________________
Post Code: ________________________________________________________
Phone / Telephone: __________________________________________________
Drivers Licence No. /
Führerschein Nr.: ____________________________________________________
General Information / Persönliche Information:
New Member & Spouse if applicable / Neues Mitglied und gegebenenfalls Ehefrau:
|
Name: |
Birth Date/ Geburtsdatum: |
Languages / Sprachen: |
Hobbies / Hobbys: |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
Children you are applying for membership for / Kinder für welche Sie Migliedschaft beantragen:
|
Name: |
Birth Date/ Geburtsdatum: |
Languages / Sprachen: |
Hobbies / Hobbys: |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
|
- |
- |
- |
- |
State your reason for joining the club / Gründe für Mitgliedschaft:
______________________________________________________________________
Two current Concordia Members have to sign for you:
Proposed by / Vorgeschlagen von ___________________________________________
Membership No. / Mitgliedschaftsnummer: _______________________
Seconded by / Unterstützt von ______________________________________________
Membership No. / Mitgliedschaftsnummer: _______________________
Date: _________________________________________________________________
Membership is for the calendar year (Jan. 1 - Dec. 31)
Current Annual Membership Fees:
Family / Familie $ 110.-
Singles / Einzelstehende $ 75.-
Single Students / Alleinstehende Studenten $ 20.-
Seniors / Senioren $ 30.-*
*Senior Membership fee applies if a member reaches the age of 65 and has been a club member for the last 5 consecutive years. In the case of a married couple, the seniors fee applies if one of the spouses reaches age 65. In this case two senior fees of $ 30.- are payable. (Senior fee is per person)
Please add $ 20.- Administration Fee on your first annual Membership Payment
Please print out this form, fill it out, attach your cheque or include your credit card number and expiration date and either FAX it to us (519)-745-5141
or
put it in the mail to: Concordia Club, 429 Ottawa Street South, Kitchener, Ontario, N2M 3P6, Canada
Once your memberhsip has been approved you'll receive your new membership cards and other information material by mail! Thank you! We look forward welcoming you in our midst!
Concordia Club Privacy Statement
Dear valued customer and prospective member:
As you may be aware, in an effort to respond to the privacy concerns of Canadians, the federal government enacted the Personal Information Protection and Electronic Documents Act ("PIPEDA"). The purpose of PIPEDA, in general terms is to regulate the private sector's collection, use and disclosure of personal information.
We would like to take this opportunity to inform you about the personal information that we collect, how it is used, how we protect its confidentiality and your rights in respect of this information.
The nature of personal information we collect may include:
Information we receive from you such as your name, address, telephone number, date of birth, languages and hobbies.
Financial information such as credit card numbers or credit reference information
Identifying information, such as a driver's license
The Concordia Club uses the information we collect for the following purposes:
To set up a membership database, tracking years of membership, committee & group membership, membership rewards and enabling us to mail to you our monthly newsletter.
To process membership payments and admission ticket purchases
To have a membership list admitting members to our membership meetings
To invite you to special functions based on age
To send out birthday cards at certain anniversaries
To track farm card access
To track farm lot usage
To respond to you and your inquiries
We recognize that your information is private and we will not share this information with a third party unless prescribed by law or you have given specific consent. Credit card information is only used to process a purchase and is not kept on file.
You have the right to request access to your personal information, which we have collected and request amendments to personal information about you to ensure its accuracy and completeness. To make a request for access to personal information we may collected, or used about you or to request that your personal information be amended, please contact our privacy officer, Mr. Peter Pijet, Manager.
We want you to ensure that you understand our need to collect and use personal information in providing our membership services. Please feel free to contact us if you have any concerns about the collection and use of your personal information by the Concordia Club. Should you wish to withdraw your consent to our collection, use or disclosure of your personal information, please contact our office, however members must also realize that a minimal amount of personal information is required in order to continue to provide membership services.
By providing your information to us you have consented to these uses and disclosures.
Sincerely
Peter Pijet, Manager