Affiliation club - Form

CLUB AFFILIATION - REGISTRATION FORM

General information

517.39$ (450$ + taxes) - for the 2023-24 season (payable BEFORE December 15th)

Curling club name*

Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Mailing address (if different from the address)

Address Line 1

Address Line 2

City

Province

Postal Code

Club phone number*

Club fax number

Club Email

Club website

Year of foundation

President details

President - First name & Last name

First Name

Last Name

President - Email

President - Phone number*

Note

Treasurer details

Treasurer - First name & Last name

First Name

Last Name

Treasurer - Email

Treasurer - Phone number*

Note

Ambassador details

Ambassadors are ressourceful volunteers who act as the liaison between Curling Quebec and its members. The ambassadors are responsible for ensuring that the members of their clubs receive all of the information in regards to programs and championships organized by Curling Quebec, they should also relay and questions or concerns from their members to the federation

Ambassador - First name & Last name

First Name

Last Name

Ambassador - Email

Ambassador - Phone number*

Note

Junior Program Coordinator details

Junoir Program Coordinator - First name & Last name

First Name

Last Name

Junior Program Coordinator - Email

Junior Program Coordinator - Phone number

Note

Choice of Payment Method

Select a method of payment*

Check Interac Bank Transfer Credit Card

Payment by Check

Affiliation fees paid by check*

517.39$ (450$ + taxes)

Payment by Interac

Affiliation fees paid by Interac *

517.39$ (450$ + taxes)

Payment by Bank Transfer

Affiliation fees paid by bank transfer*

517.39$ (450$ + taxes)

Send a check to Curling Québec, 7665, boul. Lacordaire, Montréal, QC H1S 2A7

Make a bank transfer into our BMO account (bank 001 / folio 38951 / account 1966787)

Make a bank transfer into our BMO account (bank 001 / folio 38951 / account 1966787)

Payment Credit Card

Please note that an additional transaction charge of 3.15% is added to the total amount

Affiliation fees paid by credit card*

533.69$ (450$ + taxes + 3.15%)

Credit Card Holder's Name*

Credit Card*

Quantity