Membership Renew 10 Fillable CORPORATE

2010 MEMBERSHIP APPLICATION FORM

CORPORATE LEVEL LAST NAME:

FIRST NAME:

TITLE: COMPANY: ADDRESS: CITY:

PROVINCE:

POSTAL CODE:

TELEPHONE:

FAX:

CELL:

OTHER TEL:

E-MAIL:

WEBSITE:

/

DATE

SIGNATURE:

Month

/ Year

Day

PLEASE COPY AND FILL OUT EACH CORPORATE MEMBER SEPARATELY PLEASE CHECK THE APPROPRIATE BOX GOLD LEVEL - $1,500.00 Unlimited Members - Your company will receive $1,600.00 Traffic Club User Card Plus $75.00 GST = $1,575.00 that can be spent on any event, luncheon or seminar within the current year.

$ 800.00 Traffic Club User Card

SILVER LEVEL- $ 750.00 Plus $37.50 GST = $787.50

that can be spent on any event, luncheon or seminar within the current year.

BRONZE LEVEL- $200.00 -

Two (2) Members - Your company will receive

Plus $10.00 GST =

that can be spent on any event, luncheon or seminar within the current year.

$210.00

Unlimited Members - Your company will receive

Credit Card

Payment Made By Credit Card or Cheque : Please Bill My Credit Card :

Visa

Amex

Signature

Master Card

$ 150.00 Traffic Club User Card

GST Registration # 120006648

Cheque Enclosed Card #

/

Expiry Date Signature Required

Month

Year

Fax/Mail Credit Card Information or Mail Payment To :

TRANSPORTATION CLUB OF HAMILTON, Fennell Postal Outlet, P.O. Box 61501, Hamilton, ON, L8T 5A1 Attn: Rick Gladman / Claire Ward Phone: 905-549-3777 Fax: 1-866-347-1936 E-Mail: [email protected]

www.hamiltontransportationclub.com

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