440 O’Connor Street Ottawa, ON Canada K2P 1W7 (613) 234-4119 Fax: (613) 235-2178 www.ottawacurlingclub.com OTTAWA CURLING CLUB MEMBERSHIP APPLICATION FORM, 2007-2008** ** Can also be completed on the Website: www.ottawacurlingclub.com GENERAL INFORMATION - Please prints and complete in full Name: Address: City: Postal Code: Home Telephone: ( ) Office Telephone: ( ) Facsimile: ( ) E-Mail Address: Member Since: Name Tag: Yes No Fee $10.00 DESCRIPTION FEE + GST TOTAL DUE CATEGORY A - Select a Full-Playing Membership: FULL PLAYING FEE $ 429.25 + 25.75 $455.00 $ 455.00 OCA FEE $ 12.00 + Capital Expenditure Assessment (CEA) $ 35.00 + TOTAL DUE: CATEGORY B - Select the BASE FEE plus the fee(s) for the league(s) you want to play in: BASE FEE $179.25+10.75 $190.00 $190.00 Monday Ladder $132.08+7.92 $140.00 Business Women’s League (Tuesday) $132.08+7.92 $140.00 Cash League (Wednesday) $132.08+7.92 $140.00 Business Men’s League (Thursday) $132.08+7.92 $140.00 Mixed League (Friday) $51.89+3.11 $55.00 Saturday Morning League $51.89+3.11 $55.00 Daytime league ( open) $28.30+1.70 $30.00 OCA FEE $ 12.00 + Capital Expenditure Assessment (CEA) $35.00 + Total Due CATEGORY C - Select one of the other membership categories: Fifth-Player / Spare / Practice $150.94+9.06 $160.00 Getting Started League (Tuesday Night) $198.11+11.89 $210.00 University, College League (Sunday Night) $117.92+7.08 $125.00 Little Rocks, Bantam (Capital Levy Exempt) $55.00 $55.00 Social $51.89+3.11 $55.00 Capital Expenditure Assessment (CEA) $35.00 + Total Due (See over) PAYMENT IN FULL · Select the method of payment. For payment by credit card (other than in person), complete the authorization section below. Cheque Cash Debit Card Credit Card INSTALLMENT PLANS · Available for Categories A and B. Return 4 cheques with this form, post-dated for the dates below, or pre-authorize 4 credit card payments (complete the authorization section below as well). Early-Payment Plan Four payments: June 15, July 15, Aug.15, and Sep. 15 (2007). Divide the TOTAL DUE by 4 for each payment. Deferred-Payment Plan ($10 carrying charge added) Four payments: Sep. 1, Oct.1, Nov.1, and Dec. 1 (2007) Add $10 to the TOTAL DUE, and then divide by 4 for each payment. Payment Method: 4 Post-Dated Cheques Credit Card All fees are DUE OCT. 1, 2007 (including post-dated cheques under the late-payment plan) A PENALTY OF $50.00 will be charged AFTER NOV. 1ST. $25.00 charged for NSF cheques ********************************************************************************************* Are you interested in establishing a bar / kitchen tab? YES NO CREDIT CARD AUTHORIZATION REQUIRED CREDIT CARD AUTHORIZATION MasterCard VISA Card #: Signature: Expiry Date: PERSONAL INFORMATION – Please update annually · This section is optional, but much appreciated. All responses will be kept confidential. New and Returning Members: Age Range: 6 to 14 15 to 19 20 to 39 40 to 49 50 to 59 60 and over Occupation: Hobbies, Skills or Interests: Are you interested in being an OCC volunteer? Yes No (e.g., events, committees, projects) * Privacy: The Ottawa Curling Club is committed to meeting the privacy standards applicable to every member. The OCC privacy policy includes protecting the privacy of the personal information you have provided us on this “Application for Membership”. The OCC Privacy Information Officer is the club manager. A copy of the OCC’s privacy policy is available at the club and on the website. I hereby agree to the collection and use of my personal information solely as provided for in the OCC privacy Policy, a copy of which has been made available to me. * Class B Preference share: I hereby acknowledge that my membership in the Ottawa Curling Club carries with it one (1) Class B Preference share in the Ottawa Curling Club Limited. If, for any reason, my membership in the Ottawa Curling Club is terminated, I hereby waive any claim to the said Class B Preference share. Signed Dated