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Member Online Membership Application Form 卡城華人耆英會會員申請表
會費計算日期:每年1月1日至12月31日
Membership Duration: January 1 – December 31
New Member Sign Up (成為新會員/續會)
Welcome! Please sign up for a new membership
(歡迎! 請新註冊 或 再續會員籍 )
CCECA Membership 耆英會會籍
*
Full- (Age 50+) (annual membership $20 + c.c. admin fee $1) 正式會員 (50歲 以上) (年費$20 + 信用卡手續費 $1)
-
$ 21.00
Associate- (Age 30-49) (annual membership $20 + c.c. admin fee $1) 附屬會員 (30-49歲) (年費$20 + 信用卡手續費 $1)
-
$ 21.00
Permanent (Full, Age 50+)- (Life membership $300 + c.c. admin fee $9) 永久會員 (正式 50歲 以上) (終身會員費 $300 + 信用卡手續費$9)
-
$ 309.00
Permanent (Associate)- (Life membership $300 + c.c. admin fee $9) 永久會員 (附屬, 30-49歲) (終身會員費 $300 + 信用卡手續費$9)- $309.00)
-
$ 309.00
Total Amount
Membership Application Form
First Name 英文姓名
*
Last Name 英文姓名
*
Chinese First Name 中文姓名
Chinese Last Name 中文姓名
Are you a permanent resident of Alberta? 閣下是否亞省永久居民?
*
Yes
No
Birth Date 出生日期
*
Gender 性別
*
Female
Male
Home Phone 家庭電話
*
Cell Phone 手提電話
Email 電子郵件
*
Languages 使用語言
*
English 英語
Cantonese 粵語
Mandarin 國語
Other 其他
Vietnamese
Education Level (教育程度)
*
High School (中學)
University (大學)
Postgraduate (研究院)
Other (其他)
Address 地址
*
Postal Code 郵政編號
*
Living Status (居住情況)
*
Lives Alone (獨居)
With Spouse (與配偶同住)
With Family/Friend (與家人/朋友同住)
In Facility (護理設施)
Emergency Contact - Name 緊急聯絡人 - 姓名
*
Emergency Contact - Relationship 緊急聯絡人 - 關係
*
Emergency Contact - Phone 緊急聯絡人 - 聯絡電話
*
本人明確了解參與由卡城華人耆英會及其代理人、義工、職員提供的活動、義工服務及旅遊服務之風險是由 本人個人承擔,由此導致或與之相關的任何身體及物資損失,損壞,受傷,死亡或財物損失,耆英會及其代 理人、義工、職員概不負責。 I am aware that it is a condition of participation in any program, volunteer service or travel provided on behalf of The Calgary Chinese Elderly Citizens’ Association (CCECA), its agents, volunteers, and employees that the participant does so at their own risk. CCECA, its agents, volunteers or employees are not liable for any physical or material loss, damage, injury, loss of life or cost resulting from, or in connection with such participation.
Liability Waiver
*
Yes
No
本人同意卡城華人耆英會就課程、活動、項目及耆英會服務相關之事宜聯絡本人。 I understand that CCECA will contact me for classes, events, programs and other purposes related to services provided by the centre.
Contact consent
*
Yes
No
本人同意凡參加卡城華人耆英會活動所拍攝之個人照片和影像歸耆英會所有,可作耆英會服務宣傳之用。 I agree that photos and videos taken of me during participation in any activity provided by CCECA are properties of CCECA and may be used for promotional purposes.
Media consent
*
Yes
No
Interested in Volunteer Work? 有興趣做義工嗎
*
Yes
No
Credit Card
Card Type
- select -
Visa
MasterCard
Amex
Discover
Card Number
*
Security Code
*
Expiration Date
*
-month-
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-year-
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
My billing address is the same as above
Billing Name and Address
Billing First Name
*
Billing Middle Name
Billing Last Name
*
Street Address
*
City
*
Country
*
- select -
Canada
Hong Kong
United States
State/Province
*
- select State/Province -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Postal Code
*
Review your contribution