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PGOSA
Parksville Golden Oldies Sports Association
MEMBERSHIP APPLICATION
Membership
Personal Information
Name
*
Name
First Name
First Name
Last Name
Last Name
Email
*
Home Phone
*
Mobile (Cell) Phone
Year of Birth (2 Digits)
*
Street Address
*
City
*
Postal Code
*
Membership Details
Annual Membership Fee
*
Ages 55-89, $5.50
Ages 90+, FREE
What year are you applying for?
*
Applications for the next year open after November 1st.
Name Badge
*
No Badge
Regular Pin Badge, $10.45
Magnetic Badge, $12.50
Please choose your Badge Preference from the list above.
Which areas can you volunteer?
*
Sports
Social Activities
Communication
Governance (includes membership)
Board of Directors
Membership Card Delivery Options
*
Email
via Canada Post $1.05
Your membership card will be either emailed to you or mailed via Canada Post. Please indicate your choice in receiving your membership card.
Where could you use your skills to help support PGOSA?
*
Canada Anti Spam Legislation
Canada's anti-spam legislation (CASL) requires all organizations that use electronic communications such as email to obtain explicit consent from anyone receiving the electronic communications. We require your consent to communicate with you further using email.
I agree to allow PGOSA to communicate with me by the email I have provided on this form. Select "yes" or "no".
I understand that I can opt-out at any time by choosing "unsubscribe".
*
Yes
No
PGOSA Liability Waiver
I understand that participating in a Sports Activity could result in injury. I understand it is up to me to decide whether to participate in any PGOSA Activity. I understand that the parties responsible for managing and organizing PGOSA activities assume no responsibility for personal injury to me or loss of or damage to my personal property. In consideration of participation in PGOSA, I hereby release and waive all liability for any claims that I have, or may have in future. for any loss, damage, injury or expense that I may suffer as a result of my participation in or presence at any PGOSA activities. I declare that I have read, understood and agree to the contents of this WAIVER in its entirety and I accept it freely and voluntarily without any inducement.
I have read and agree to accept the conditions of the PGOSA Liability Waiver.
*
Yes
Payment
If you experience issues paying online, or click the "submit" button while Stripe is connecting and inadvertently see a duplicate charge to your account, please contact membership@pgosa.org. We will advise as to the next steps to expedite any potential refund or possible fixes for any connection error.
Amount Due:
Payment
*
Captcha
Submit
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