2010 MEMBERSHIP APPLICATION FORM

CORPORATE LEVEL

LAST NAME: FIRST NAME:

TITLE:

COMPANY:

ADDRESS:

CITY: PROVINCE:

POSTAL CODE: TELEPHONE:

FAX: CELL: OTHER TEL:

E-MAIL: WEBSITE:

SIGNATURE: DATE / /
Month Day Year

PLEASE COPY AND FILL OUT EACH CORPORATE MEMBER SEPARATELY

PLEASE CHECK THE APPROPRIATE BOX

GOLD LEVEL - $1,500.00 - Unlimited Members - Your company will receive $1,600.00 Traffic Club User Card
Plus $75.00 GST = $1,575.00 that can be spent on any event, luncheon or seminar within the current year.

SILVER LEVEL- $ 750.00 - Unlimited Members - Your company will receive $ 800.00 Traffic Club User Card
Plus $37.50 GST = $787.50 that can be spent on any event, luncheon or seminar within the current year.

BRONZE LEVEL- $200.00 - Two (2) Members - Your company will receive $ 150.00 Traffic Club User Card
Plus $10.00 GST = $210.00 that can be spent on any event, luncheon or seminar within the current year.

GST Registration # 120006648

Payment Made By Credit Card or Cheque : Credit Card Cheque Enclosed

Please Bill My Credit Card : Visa Amex Master Card Card #

Signature Expiry Date /

Signature Required Month Year

Fax/Mail Credit Card Information or Mail Payment To :

TRANSPORTATION CLUB OF HAMILTON, Fennell Postal Outlet, P.O. Box 61501, Hamilton, ON, L8T 5A1
Attn: Rick Gladman / Claire Ward Phone: 905-549-3777 Fax: 1-866-347-1936 E-Mail: hamtransportation@cogeco.ca

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