Please print this blank form on your printer, then fill in the details clearly, and return with your membership dues to the address below, or in person. Thanks

              LONDON MUSIC CLUB

        470 Colborne Street, London, ON, Canada N6B 2T3 (519)640-6996

                                            Membership Form

                                                               check one:

Single Membership:  [   ]  1 Year @ $45+HST  = $50.85     [   ] 2 Year @ $80+HST = $90.40
Family Membership: 2 person  [   ]  1 Year @ $80+HST  = $90.40    [   ] 2 Year @ $140+HST = $158.20
Students/Seniors/Working Musicians  [   ]  1 Year @ $40+HST  = $45.20      [   ] 2 Year @ $70+HST = $79.10

Please print this blank form on your printer, then fill in the details clearly, and return with your membership dues to the address above, or in person.

 

Name:_______________________________________________________________

Other Name (if Family Membership)                                                                  
 

Address:___________________________________________________________________

City:________________ Prov.:_______________ Postal Code:______________________

Email:______________________________   Phone(s): ___________________________


Date:                                
     New  (   )  or Renewal (   )
 

Would You like to Volunteer here @ the LMC?   Yes / No

Your signature:                                                                                      

Please print this blank form on your printer, then fill in the details clearly, and return with your membership dues to the address above, or in person. Thanks