Hiking Club Membership Registration Form

Membership Registration Form
Membership Type:
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Single Membership
$34.00 CAD

Family Membership
$55.00 CAD

ACCVI Associate Membership
$21.00 CAD

FMCBC Associate Membership
$13.00 CAD

Student Membership
$20.00 CAD

Total
$0.00 CAD
FMCBC Parent Club:
School Name
Student Number
Applicant's Legal Name
First NameMiddle NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Applicant's Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Additional Applicants
Family memberships allow for a maximum of four members. If your family has more than 4 members over the age of 10 years of age, please complete additional applications using "student" as the membership type.
1st
First NameMiddle NameLast Name
Email
example@example.com
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
2nd
First NameMiddle NameLast Name
Email
example@example.com
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
3rd
First NameMiddle NameLast Name
Email
example@example.com
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contact
Emergency Contact Name
First NameLast Name
Emergency Contact Email
example@example.com
Emergency Contact Phone Number
Format: (000) 000-0000.
Consent
I understand that my name, membership status, and the date I signed the IMR waiver will be shared with club trip leaders.
Should be Empty:

Membership Registration Form

Membership Type:*

Additional Applicants

Emergency Contact

Consent

Membership Type: