Jocko’s Friends Membership Form

Use this form to submit your Jocko’s Friends membership request online and pay via Interac e-Transfer.

Member Info
Jocko's Friends Member Names*
Click the (+) to add a new member.
First Name Last Name Birth Date
Parent/Guardian Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City Province Postal Code
List any allergies:
Permission to take/use photo*
- YES - I as parent/guardian DO give permission for Jocko's Friends to take/use the above member's photo in the newsletter and on the website.
- NO - I as parent/guardian DO NOT give permission for Jocko's Friends to take/use the above member's photo in the newsletter and on the website.
Payment Info
Membership Type*
- New Member
- Annual Renewal
One year Membership Payment Quantity*
Price: $ 5.00 CAD
Five year Membership Payment Quantity*
Price: $ 20.00 CAD
Total
$ 0.00 CAD
Consent*
I agree to pay the above total via e-Transfer.
Once the form is submitted, send an Interac e-Transfer in the amount above to payments@govhousesociety.ca to complete your membership registration.
Phone
This field is for validation purposes and should be left unchanged.

Member Info

First Name	Last Name	Birth Date