Membership Application

Name:
Date of Birth:	Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 1886 1885 1884 1883 1882 1881 1880 1879 1878 1877 1876 1875 1874 1873 1872 1871 1870 1869 1868 1867 1866 1865 1864 1863 1862 1861 1860 1859 1858 1857 1856 1855
Residence Address:
Telephone:	E-mail:
Title/Occupation:
Business Address:
Business Telephone:	Fax:
Business Email:
Preference for club mailings:	Residence Business
Other Club Affiliations (Rotary, RKYC, etc.)
Age Group:	21-35   35-60    60plus Retired
Membership Category Applied for:	Member Intermediate Senior Lady Senior Nonresident Corporate     ( See categories below )

If elected, I agree to abide by the Club by-laws and rules, and to pay my dues in accordance with Club rules.

Proposed by:
Seconded by:

A deposit of first quarter dues must accompany each application for membership.
This deposit will be applied against the quarterly membership dues billing.
All prices are subject to HST.

Pre-authorized Credit Card Forms are available at the club.
You may call or drop by with this info.

Summary of Membership Categories		Annual Dues
Member A member who is at least 35 years of age and whose fixed place of residence or chief place of business is within a 50 mile radius of the Union Club.		$440.00
Intermediate A member who has not attained the age of 35 years and whose fixed place of residence or chief place of business is within a 50 mile radius of the Union Club.		$294.00
Senior A Member who retired from active business and is at least 60 years of age.		$380.00
Lady Senior A Member who retired from active business and is at least 60 years of age.		$218.00
Other (Non-resident) A Member whose fixed place of residence and chief place of business are both beyond a radius of 50 miles of the Union Club. Non-resident members must pay full year membership upon joining.		$290.00
Corporate An organization with five or more Members in the "Member" category.		$380.00