Media Club of
Ottawa
Send this
form directly to the Media Club of Ottawa
See instructions at the bottom of the form
Application
Form - Formulaire d'adhésion
Personal
Information - Coordonnées
Name of
applicant - Nom du postulant: ____________________________
Address -
Adresse: ____________________________________________
__________________________________________________________________
Phones -
Téléphones: Home - à domicile: ____________________
Business -
bureau: ________________ Fax: _______________________
E-mail address -
courrier électronique: _____________________________
Employer - Employeur: _______________________________________
Job title or
position - Occupation: _______________________________
Duties which
qualify your membership. Responsabilités justifient acceptation:
________________________________________________________________________
Membership
category. Catégorie pour laquelle vous faites la demande:
Active - Actif __
Associate - Associé ___
Non-Resident __
Student - Étudiant ____
Sponsors -
Parrains (must be members of the club in good standing -
membres en
règle)
(PRINT)
___________________________________
Signature ________________________
Seconder -
co-parrain - (PRINT) ________________________________
Signature ________________________
Signature of
Applicant - Signature du postulant:(Print)
_____________________________
Date of
application - date de remise de l'adhésion:
___________________________
Note: Please copy
and paste this form directly into an email to Iris
How to
- Highlight the
form and copy (CTRL c); then click on the link above (Iris)
to open your email account.
- Paste
directly into the body of the email, fill in and send.
This will constitutue your intention to
join the Media Club of Ottawa.
We will contact you to
finalize the procedure..
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