New Membership________________________ OR Renewal Membership_____________________
Name______________________________________________________________________________
Address____________________________________________________________________________
City_______________________ Province ___________________ Postal Code__________________
Telephone _____________________________ Email ______________________________________
Please Circle the Type of Membership Required Below:
Regular 1 Year = $25.00 Regular 3 Year = $60.00 Family 1 Year = $30.00
Junior 1 Year (16 years or under) = 10.00 Senior 1 Year (age 65 and over) = $25.00
List all Names for Family Membership New Renew
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NOTE: For Family Membership, all correspondence will be addressed to the person first named above.
Club/Chapter Affiliation (where applicable) __________________________
I am interested in the following:
Formation of a Chapter in the area of: ______________________________
Stream Rehabilitation ________ Egg Collection/Adult Transfer ________ Committee/Director Work ________
I have enclosed a cheque/money order for $________ with this membership application, payable to The
Ontario Steelheaders at the above address.
Please allow 3 weeks from time of receipt of this application, for mailing of Membership Cards, crests and decals.