Membership Application Form

Coureurs de Bois - Membership Form

Annual membership is $20 (single or family). A surcharge of $1 will be automatically added. A total of $21 will appear in the shopping cart. Please review the information before submitting.
Select year for annual membership*
Are you renewing your membership for the year selected?*

YesNo
How did you find the CdB?

FriendInternetBrochureWord of mouth
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
E-mail*
Home Number*
Cellular Number
Overall Health*

ExcellentVery goodAverageFairPoor
Special Medical or Physical Disabilities
Signature of primary person*

Clear
Would you like to register a second person residing at the same address?

YesNo
Register a second person to your family membership
Name of second person

First NameLast Name
E-mail
Cellular Number
Overall Health

ExcellentVery goodAverageFairPoor
Special Medical or Physical Disabilities
Signature of second person

Clear
Enter the message as it's shown*
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annual membership + $1 surcharge$21.00CAD
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Coureurs de Bois - Membership Form