	Manitoba Highland Dancers' Association	2009 - 2010 Membership Application Form

Membership Registration Information

Please check one. * - mandatory to be entered

* (One of The Following)

Is this your first time registering?

If it is before April 1, 2010, please complete the forms. Make your Membership cheque of $40.00
payable to MHDA. Please enclose a $100.00 Volunteer cheque payable to MHDA (post-dated to
July 31, 2011). You must volunteer before July 31, 2010 to avoid having your cheque cashed.
If it is after April 1, 2010, please complete the forms. Make your Membership cheque of $40.00
payable to MHDA. Please enclose a $100.00 Volunteer cheque payable to MHDA (post-dated to
July 31, 2011). You must volunteer before July 31, 2011 to avoid having your cheque cashed.

Did you join after April 1st 2009 as a New Member?

Your membership is still valid. Please complete the forms but DO NOT include a $40.00
Membership cheque or a $100.00 Volunteer cheque.

Are you a Renewing Member?

Please complete the forms. You must provide a Membership cheque for $40.00 payable to
MHDA and a Volunteer cheque for $100.00 payable to MHDA (post-dated for July 31, 2010).
You must volunteer before July 31, 2010 to avoid having your cheque cashed.
If it is after September 30, 2009, please add the $10.00 late fee to your Membership cheque
(which would now total $50.00).

Are you an Honorary Member?

Please complete the forms. You are NOT required to submit a Membership cheque or a
Volunteer cheque.

Are you an Associate Member, or wish to become an Associate Member?

Please complete the forms. You must provide a Membership cheque for $20.00 payable to
MHDA. No Volunteer cheque is required. Please note, as an Associate Member, you have no
voting privileges at our Annual General Meeting.

IMPORTANT: A Volunteer cheque MUST accompany the Membership
application (unless otherwise noted), or your Membership
will not be acknowledged. NO EXCEPTIONS!

Volunteer cheques can be mailed to:

Diana Simpson
MHDA Membership Director
80 Tahoe Bay
Winnipeg, MB R2J 2W4
Tel: (204) 772-6600
Email: dianasimpson@mts.net

Closing date for membership renewal is
SEPTEMBER 30, 2009
Only one membership per family is required.
MEMBERSHIP RENEWALS NOT SUBMITTED BY SEPTEMBER 30, 2009 WILL BE SUBJECT TO
A LATE PENALTY OF $10.00.

Member Information

* Surname

Mother's Name Father's Name

* Address City Postal Code

* Telephone # (Home) - Business # - Cell # -

* Email address

* Would you like to receive your entry forms and newsletter by email?
Yes No

* Name of Dancer * Teacher

Birthdate:

Name of Dancer Teacher

Birthdate:

Name of Dancer Teacher

Birthdate:

* Would you like to participate in danceouts? Yes No

WAIVER

In consideration of your accepting this membership Inc., I hereby for myself, my heirs, executors and administrators waive and release any and all rights and claims for damages I may have against the Manitoba Highland Dancers Association Inc., and its agents, representatives, successors and assignees for any and all injuries suffered by me, any member of my family or any person under my custody, control or guardianship at any and all voluntary events or activities sponsored by M.H.D.A. Inc. A parent or guardian must sign this waiver if a dancer is under 18, before this membership will be accepted. Photo release: I give permission for the Manitoba Highland Dancers Association Inc. to use my photograph for publicity purposes.

* I Agree

Membership Registration Information

Please check one. * - mandatory to be entered

Is this your first time registering?

Did you join after April 1st 2009 as a New Member?

Your membership is still valid. Please complete the forms but DO NOT include a $40.00 Membership cheque or a $100.00 Volunteer cheque.

Are you a Renewing Member?

Are you an Honorary Member?

Please complete the forms. You are NOT required to submit a Membership cheque or a Volunteer cheque.

Are you an Associate Member, or wish to become an Associate Member?

Please complete the forms. You must provide a Membership cheque for $20.00 payable to MHDA. No Volunteer cheque is required. Please note, as an Associate Member, you have no voting privileges at our Annual General Meeting.

IMPORTANT: A Volunteer cheque MUST accompany the Membership application (unless otherwise noted), or your Membership will not be acknowledged. NO EXCEPTIONS!

Closing date for membership renewal is SEPTEMBER 30, 2009 Only one membership per family is required. MEMBERSHIP RENEWALS NOT SUBMITTED BY SEPTEMBER 30, 2009 WILL BE SUBJECT TO A LATE PENALTY OF $10.00.

Member Information

WAIVER

Your membership is still valid. Please complete the forms but DO NOT include a $40.00
Membership cheque or a $100.00 Volunteer cheque.

Please complete the forms. You are NOT required to submit a Membership cheque or a
Volunteer cheque.

Please complete the forms. You must provide a Membership cheque for $20.00 payable to
MHDA. No Volunteer cheque is required. Please note, as an Associate Member, you have no
voting privileges at our Annual General Meeting.

IMPORTANT: A Volunteer cheque MUST accompany the Membership
application (unless otherwise noted), or your Membership
will not be acknowledged. NO EXCEPTIONS!

Closing date for membership renewal is
SEPTEMBER 30, 2009
Only one membership per family is required.
MEMBERSHIP RENEWALS NOT SUBMITTED BY SEPTEMBER 30, 2009 WILL BE SUBJECT TO
A LATE PENALTY OF $10.00.