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Membership

Membership Application Form

Members must be at least 55 years old.
Memberships run on a calendar year basis. Memberships are non-refundable under any circumstances.

2014 Memberships for the remainder of the year

$17 plus option of a $3 parking tag

Mail application form and membership fee to:
Kerby Membership
1133-7 Ave.  SW
Calgary, AB T2P 1B2

or pay online using Paypal.

Fill out the form below, then you can make a payment by Paypal.

Membership Type

Your Name (required)

Member name, if purchasing for someone else

Street Address

City

Province

Postal Code

Telephone

Mobile Phone

Email (required)

Year of Birth

Additional Details

Parking

License Plate (Only if paying for parking)

Emergency Contact

Emergency Contact Phone

Please Select the way you want to read Kerby News

Please select one of the following:
 I will pick up my membership card the next time I am in the building Please mail my membership card I do not need a membership card

By submitting this on-line registration with my payment I am declaring my desire to be a member of Kerby Centre. I declare that I am 55 years or older. I understand that all activities of Kerby Centre are governed by the Bylaws of the Society
 I Agree

Confidentiality: I understand that the information collected on this form is held in confidence and kept in secured files. It will only be used for Kerby Centre purposes and will not be given to any other organization. This information will be securely disposed when my membership has been inactive 7 years or upon my request.

 I Agree

Parking: I understand that parking is permitted only when in the building or when engaged in Kerby Centre activities elsewhere.
 I Agree