CLUB
EROS . . .
Full name (his)
_______________________________
Preferred first name: _____________
(for your name badges)
Full name (hers)
______________________________
Preferred first name: _____________
Address: ____________________________________________________ Apt: __________
City: ________________________ Province/State: _______ Postal/Zip Code: _____________
Date: ___________ Phone: ( ) ___________ E-Mail Address: _______________________
Birthdates: (his) _________________ (hers) __________________ Married: [ ] Yes [ ] No
Type of membership applied for: (see our Main Page for details of membership types)
[ ] Regular Silver Card -
$89/couple/year
[ ] Long distance Silver Card - $45/couple/year
- $45/single
bi-woman/year
(only available if you live 200 mi. or more from
Toronto)
[ ] Gold Card - $329/couple/year
- $165/single
bi-woman/year
Important: All memberships are subject to 6% GST.
Payment in full (including GST) must accompany your
application or it will be returned to you.
It is understood that both partners know and approve
of membership in this group.
Memberships are granted to a couple as a unit,
neither
is a member, nor may attend without the other.
Single lady members must attend as singles & are
not permitted to bring guests without prior club approval.
Memberships, once approved, are non-refundable.
Signatures: (his)
__________________________
(hers)
_______________________________
CREDIT CARD OPTION:
We are now pleased to offer credit card payment for memberships.
To apply for membership by credit card or "Interac by Email" ON LINE, please go to this form.
To apply for membership by fax or mail, print out this page and send
it to us. (address & number below)
PLEASE PRINT CLEARLY AND LEGIBLY!!
Please charge my credit card with the amount of : $ ___________ (Don't forget to include GST!!)
[ ] American Express [ ] Mastercard [ ] Visa
Card Number: [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Expiry Date: Year: [ ] [ ] Month [ ] [ ]
Printed Name EXACTLY as it appears on the card:
_________________________________________
Signature: _________________________________________________________________________