NAME: ____________________________________________________________________________ STREET ADDRESS: _______________________________________________________________ CITY: _______________________________________ POSTAL CODE: ______________________ TELEPHONE NUMBER: (519) ________________________________ EMAIL ADDRESS: _________________________________________________________________ FIRST NAME OF WIFE OR PARTNER: _______________________________ INTERESTS: Please list your interests, hobbies or talents which could be shared or be of benefit to members of the Club. ___________________________________________________________________________________ ___________________________________________________________________________________ COMMITTEES: Please check off any committees you would be willing to serve on

Programme (Speakers, Tours)	___	Activities (also Events, eg. Barbecue)	___
Membership (Applications, Directory, Health)	___	House (Meeting arrangements, AV Equip.)	___
Communications (Newsletter, Website)	___	Finance (Financial affairs, Budgets)	___

Please submit to Ralph Shaw, RCMC Treasurer, 75 Shadybrook Crescent, Guelph, ON, N1G 3H6 or Ron Usborne, RCMC Membership, 6 Trillium Court, Guelph, ON, N1G 4P8. -------------------------------------------------------------------------------------------------------------- Area below for Club Administration

SPONSOR'S SIGNATURE: ___________________________________________

DUES PAID: __________________________ DATE:________________________

COMMENTS:_______________________________________________________________________

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Reviewed by:

Membership ___ Treasurer ___ Directory ___