ࡱ> ^`] bjbj %frr`````ttttDDt5j:6666$Q z`"``66y `6`66pߧQA05, d  `U5  &:  MEMBERSHIP APPLICATION FORM  SHAPE \* MERGEFORMAT  ۲ݮƵ Faculty Club & Conference Centre 3450 McTavish Street / Montral, QC H3A 1X9 Phone: (514) 398-5537 Fax: (514) 398-5105  HYPERLINK "http://www.mcgill.ca/facultyclub" www.mcgill.ca/facultyclub B: Alumni and Business Professionals Prof.  Dr.  Mr.  Mrs.  Ms.  Given Name(s) Surname Office Address : ___________________________________ ______________________________________________  Work#___________________ E mail _____ Home Address : ___________________________________ ______________________________________________  Home Phone: _________________________  ۲ݮƵ Affiliation or Connection:  Please indicate address to which monthly statements should be mailed Home: Office: I hereby authorize the deduction of the annual membership dues and house accounts payment via cheque (payment due within 30 days) or credit card (automatic payment taken in the 1st week of each month when statements are released) In the event of payment by cheque a valid credit card will be needed. Please fill out the credit card form attached. Signature: ____________________ Date: _________________________ NOTE: All annual membership dues are charged yearly in June. All ۲ݮƵ statements of accounts will be sent to the address checked above. No statements will be sent to the credit card payers (unless requested) Payment is deducted automatically. All renewal membership that would like to be cancelled must be done prior to April 1st of every year. No reimbursement will be issued after this date. This must be done via e-mail. Please send via e-mail to Natasha Sharma (Membership Services) It is the members responsibility to inform of us of any address changes. To replace a membership card there is a fee of $5.00 plus taxes Members are encouraged to follow the Hours and Rules of the Faculty Club which are indicated on the website of ۲ݮƵ Faculty Club. For inquiries regarding membership: Natasha Sharma at Membership Services. 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