2018 EJCA Membership Application Form

(*indicates the fields that you must fill in)

Please mail this EJCA application form with a cheque payable to EJCA, addressed at 6750 88 Street, Edmonton, Alberta, Canada T6E 5H6, or drop off at the Office. The fee can be paid online by the Paypal. Please go to

* Date of application: ______

* First name: ______, * Lastname: ______(Anotherlast name: ______)

If family membership: Spouse First name: ______Spouse Last name: ______

Dependents: Child 1: ______Child 2: ______

Child 3: ______Child 4: ______

*Address: ______, * City: ______

* Province: ______, * Postal code: ______* Telephone: ______

Email (member): ______Email (spouse): ______

Emergency contact name: ______Emergency contact telephone ______

As a member of EJCA, I give my consent to receive emails from EJCA regarding programs, events, updates, and inquiries.

EJCA会員として、EJCAよりプログラム、行事案内、お知らせなどのe-mailを受け取ることに同意します。

Please (✔) applicable items:

*1. New or renewal: ( ) This a new membership or ( ) This is a renewal

*2. Membership: paid by ( ) cash ( ) cheque ( ) PayPal

( ) Family membership (two or more members in one household)$35.00

( ) Single membership$20.00

( ) Senior family membership with both over 70 years oldFree

( ) Senior family membership with one is over 70 years old $20.00

( ) Senior single membership (over 70 years old)Free

*3. Newsletter Moshi Moshi subscription:( ) on-line or ( ) on paper

4. Check all clubs where yourself and/or any of your family is a member

( ) Bonsai Club( ) Calligraphy ( ) Gojukai Karate Club ( ) Ikebana Club ( ) Jodo Club ( ) Karaoke Club ( ) Kimono de Jack ( ) Kita no Taiko ( ) Matsu no Kai (55-up) ( ) Nihongo Kaiwa Club

( ) NobaraChorus ( ) Table Tennis Club ( ) Wakaba-kai ( ) Women’s Karate ( ) Japanese class

5. Check all EJCA committees and volunteer tasks that you are interested in:

( ) Bazaar volunteer ( ) Culture Programsvolunteer( ) Events volunteer ( ) Heritage Festivalvolunteer

( ) Garden Committee ( ) Heritage Festival Committee( ) Library Committee

All personal data are used for EJCA’s internal use only.

Photos and video of EJCA activities may be posted in the newsletter or EJCA website.If you do not wantyour images posted, please avoid camera.

ＥＪＣＡの活動は写真やビデオの形で、インターネットのホームページや会報に掲載される事があります。写真やビデオが掲載されたくない方は、写真やビデオに写らないようにしてください。