MemberShip Application Form – CANADIAN KERALA CULTURAL ASSOCIATION OF ALBERTA

Membership Application Form

Select New or RenewalNew membershipRenew membership

Name of Applicant *

Name of Spouse

Street Address

City

State/Province

Postal Code

Country

Phone Number *

Email Address *

How many children do you want to add

Name of Child - 1

Name of Child - 2

Name of Child - 3

Name of Child - 4

Name of Child - 5

Membership Option *Annual Individual Membership - $25Annual Family Membership (2 adults & children under 18) - $50Annual Student Membership (or dependent children under 25) - $5Lifetime Individual Membership - $250Lifetime Family Membership (2 adults & children under 18) - $500Please select type of membership

Total Membership Fee

$

Fee Payment

By Credit/Debit card (recommended) or by e-transfer to: accounts@albertamalayalee.ca

Choose your payment methodPay by Credit/Debit CardSend by e-transfer

Credit / Debit Card *