Become a Member / Ser Miembro
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Copyright (C) 2007 Barrie Latin Community Centre. All Rights Reserved.
B.L.C.C. MEMBERSHIP
Barrie Latin Community Centre
Membership Application
Dear Community Centre Board Members, please take this application as my formal request to
become a member for the period of:
Start Date (m/yr):
 End Date (m/yr):
Member Information:
Date of Birth
(m/d/yr):
Full Name:
Address:
City:
 Province:
Country:
 Postal Code:
Sex:
 M
 F
 Phone Number:
Email Address:
Please tick your interest in the Centre:
Health Programs / Programa de Salud
Immigration Program / Programa de inmigracion
Cultural and Social Programs/Programa Culturales y Sociales:
Language / Lenguaje
Music / Musica
Dance / Danza
Art / Arte
Sport / Deporte
Social Assistance / Asistencia Social
Other Skills or Interests:
Complete this section if family or
single parent family Membership:
Dependant/s Name:
 Date of Birth:
1.
 1.
2.
 2.
3.
 3.
4.
 4.
5.
 5.
In case of emergency contact:
 Name:
Phone Number:
Terms and Conditions:
I/We hereby apply for membership in the Barrie Latin Community Centre and its facilities and hereby agree to all
regulations of the centre. Falsification of any part of this application will result in the loss of my/our membership and
forfeiture of all moneys paid. Proof of I.D.  may be required at the B.L.C.C. Management. I authorize the B.L.C.C. to put me
on their mailing/email list. I understand that if I do not want to be on their mailing/email list I must notify them in writing. I
give permission for my and/or my family's picture to be taken or used in any B.L.C.C. materials. I understand that if I do
not wish to have pictures taken or used by the B.L.C.C. I must notify the B.L.C.C. in writing.
Do you agree to the above terms and conditions?
 Yes