Student     Other  

BASIC INFORMATON:

Name (First, Last):     Mr. Mrs. Master Ms.  

Street Address:               City:   

Province/State:                Postal/Zip Code:    

Country:   Canada USA

 Telephone:

    Res.:   Bus.:   Cell:  

Email:   

FAMILY INFORMATION:

FAMILY MEMBERS:

Method of Payment:   Cash Cheque

I am    mailing delivering     the cheque to 671 Esprit Crescent, Mississauga Ontario, L5R 3B9, Canada.

PROGRAM: Series of mini concerts (Minimum 4-5 per year)

(Membership open to non-students as well)

**Membership shall expire on the 31st of December every year, regardless of the submission date of the membership form. Renewal Subscription fee collection for the following calendar year will begin on January 1st. Membership cards will be issued and can be mailed or collected personally**