Individual Membership Application 2012-2013

To submit a membership application, please complete and submit this form. Please note that you must fill out fields that are marked with an asterix (*).

Website Account Information

Once your membership is finalized, you'll use this information to log into the YHMA website.

Username *

Password *

Confirm Password *

Contact Information

Title

First Name *

Last Name *

Home Address *

City *

Province or Territory *

Postal Code *

Country *

Home Phone Number *

Cell Phone Number

Email Address *

Membership Level

Please select the level of membership for which you are applying.

Student/Senior (55+) Membership: $15.75
Basic Individual Membership: $26.25
Family Membership 2 adults and 2 children (under 18): $47.25
Individuals Providing Heritage Services Membership: $52.50

Payment Method

Please select the method you will be using to pay for your membership. We cannot accept payment online. Instructions for sending your payment to us will be included in an email you'll receive after you submit this form.

Cheque
Cash
Credit Card

Communication Method

Please indicate how you would like to receive the YHMA newsletter, information about our AGM, special event notifications, membership renewal notifications, and other updates from us.

Email
Post

Human Verification

By verifiying the characters in the box below, you will help us reduce fraudulent, machine-submitted membership applications.