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In Accordance With the Canadian Privacy Act:

I acknowledge and agree that the submission of this membership information constitutes my consent to the use and limited disclosure in order to prepare statistical reports, birthday lists, and for the purpose of fulfilling the mandate of the Blenheim Community Senior Citizens' Group.
Do you accept the privacy statement above?(Required)
Check this box to confirm your acceptance of our privacy statement as described on this form.

Travel Waiver

I, of my own free will, agree when I travel with the Blenheim Community Senior Citizens' Group on various day trips or extended trips, I will in no way hold the Blenheim Community Senior Citizens' Group or any of its members responsible in the event of an accident or calamity, for my personal care or safety at any time during the trip.
Do you accept the travel waiver statement above?(Required)
Check this box to confirm your acceptance of our travel waiver as described on this form.
Would you be interested in volunteering?(Required)

Please Pay By Cheque to: Blenheim Community Senior Citizens' Group

Someone will be in touch with you after we receive your membership application. If you wish to send your cheque in by mail, you may send it to the following address:

  • Blenheim Community Senior Citizens' Group
  • 55 Jane Street
  • Blenheim, ON
  • N0P 1A0

Approved by the board of directors.

This field is for validation purposes and should be left unchanged.