APPLICATION FOR MEMBERSHIP

("THE CO-OP") on this the 20 I hereby apply for
(full name of Co-operative)

membership in the Co-op and apply for common shares of the Co-op for the total price of $ and request that you allot them to me.

 

I understand that I will become a member only after board approval of this membership application. Upon becoming a member, I agree to be bound by the bylaws and policies if the Co-op, as amended from time to time. I agree that the Co-op shall have lien on the equity which I may have at this any time in the Co-op, including my shares and all funds arising from Patronage refunds of dividends, for any monies at any time owing by me to the Co-op. All shares and patronage refunds of dividends shall be held in the name of the applicant only.

 


Signature of Witness


Signature of Applicant or Corporate Signing Officer


Surname / Business Name
First Name
Address I  
Address II
Postal Code		 Country

City
Province
Telephone Number

Zip Code - If not Canada
Birth Date
Social Insurance Number

Occupation		    

Date Accepted by Board 		   

Membership Number