APPLICATION FOR ACULPECA MEMBERSHIP

ACULPECA MEMBERSHIP APPLICATION FORM

Personal Data
E-mail
Family Last Name
Address
City
Province
Postal Code
Phone Number (home)
Phone Number (work or cell )
Anniversary Date MM/DD/YYYY (optional)

Please give full information for each family member. Note: When applying as family, dependents are considered the spouse and all children under 18 years of age or students.
Name of Applicant
Birthdate (MM/DD/YYY)
Nationality
Name of Spouse
Birthdate (MM/DD/YYY)
Nationality

Note: Space is given for up to 4 children per family. Please use the "Additional Children" box below to add names and birthdates of additional children in your family.
Child 1 - Name
Birthdate (MM/DD/YYY)
Child 2 - Name
Birthdate (MM/DD/YYY)
Child 3 - Name
Birthdate (MM/DD/YYY)
Child 4 - Name
Birthdate (MM/DD/YYY)
Additional Children

To the best of your ability, please explain your reasons for wanting to become a member of the Canadian Peruvian Cultural Association. Please state the expectations you would have of ACULPECA as a member.
Reasons for joining
Expectations of ACULPECA
How did you hear of us?
Membership payment is accepted by cheque payable to Canadian Peruvian Cultural Association. Your can drop your cheque off or mail it to: 10370-60 Avenue, Edmonton, AB T6H 1G9
Annual Membership Fee



For Office Use Only:

For Office Use Only:

Referral for Membership

  • Person used as referral must be a member in good standing as per the By-Laws of the Association
  • Person used as a referral must have agreed to act in that capacity.
    • Name of Referral
    Years Known
    Referral has Agreed?

  • In making this application, I understand that my membership and any activities I am engaged in while being a member of the Association are subject to the rules as set out in the By-Laws of the Association.
  • I understand that application is subject to evaluation as set out by the By-Laws of the Association.
  • I understand that by typing in my name and the date of application below and then submitting this form, I am making my signature digitally.
    • Type your full name here:
    Type date of application here:
    Application approval/rejection is signed and dated by the President of the Association on behalf of the Association.
    For Office Use Only:



    For Office Use Only: