Società Caruso - Sudbury Ontario

NOTE: There's a $10 one-time administration fee included in all new member applications.

Student ID#: Student Use Only

Name(s):		Date of Birth: (DD/MM/YYYY)
Primary Member:	*	*
Spouse:
Child:
Child:
Child:
Child:

Address:	*
Mailing Address: (if different from above)
Postal Code: (A2A 2A2)	*
Email:	*
Phone Number:	*
Business Number:
Cell Number:
	Sponsored by:	Date: (DD/MM/YYYY)

I hereby, give the Società Caruso permission to use images captured during events and on premises, for promotional and public use.

(* indicates a required field)