Hounsfield Heights/Briar Hill Community Association Membership Registration

(*) = required

Family Name - Adult 1 (*)

First Name - Adult 1 (*)

Family Name - Adult 2

First Name - Adult 2

First Name - Child 1

Last Name - Child 1
(if different from family name 1)

Birthmonth (mm) / Birthyear (yyyy) Child 1

First Name - Child 2

Last Name - Child 2
(if different from family name 1)

Birthmonth (mm) / Birthyear (yyyy) Child 2

First Name - Child 3

Last Name - Child 3
(if different from family name 1)

Birthmonth (mm) / Birthyear (yyyy) Child 3

First Name - Child 4

Last Name - Child 4
(if different from family name 1)

Birthmonth (mm) / Birthyear (yyyy) Child 4

More than 4 kids: Please put the name, birthmonth and birthyear into the comment field.

Street (*)

Street 2

City (*)/Postal Code (*)

Province/State (*)

Country (*)

Phone (*)

Cell Phone

E-mail

Would you like to receive
the newsletter by email?

Membership Type (*)

	$20 per household
	$10 for seniors

Payment Type (*)

	Paypal (incl. Debit/Credit)
	Cheque

I would be interested in volunteering for:

If PayPal is selected as payment type, you will be directed to our payment page.

If you have any questions please contact our administrative assistant at
(403) 282-6634
or email
admin@hh-bh.ca