Membership Application

Your Information

Your Name

Street Address *

Town *

Postal Code *

Phone *

Emergency Contact Phone *

Email Address *

Do you have Smart Serve training? This is required to work bars. *YesNo

Are you interested in training?YesNoTraining takes several hours.

Do you have the Safe Food Handling course? This is useful training when handling food. *YesNo

Are you interested in training?YesNo

Mentoring Information

Mentor's Name *

Dates of Membership Meetings Attended

First date *

Second date *

Projects Worked

First project *

Second project *

Areas of Interest

As we organize workers and get new members participating in the club, it helps us to know what you are interested in doing. Please check off all that apply:

The list is by no means complete but does offer a range of possibilities. Check all that apply.

Agreement

I hereby request membership in the Almonte Civitan Club. Upon acceptance, I agree to be subject to its Constitution, Bylaws and official policies. I also agree to pay any necessary initiation fees and regular annual dues to the club, district and Civitan International as determined by the Club. I understand that a portion of the regular membership dues may be subsidized by the Almonte Civitan Club as incentive for member recruitment and participation. I further agree to be a willing, active participant in club events and activities to the best of my ability and availability.

I agree to the terms above. *YesNo

Thank you for your interest in becoming a member of the Almonte Civitan Club.

Your Information

Mentoring Information

Contact us

Follow us