VANCOUVER MOKUYOKAI SOCIETY           Membership Application Form
     
Mail this membership form, along with a cheque or money order for your 
membership fee, to:     Membership The Vancouver Mokuyokai Society 
                        P.O. Box 48901 Bentall Station 
                        Vancouver, B.C. V7X 1A8 Canada
*** Please make cheques payable to The Vancouver Mokuyokai Society. ***

Membership Types/Annual Due
Individual Membership --$40/year       Student Membership --$20/year
Family Membership --$55/year       JET Alumni (1st year only) --$20/year

Principal Member
Title: ___________ First Name: ______________ Last Name:__________
Street Address:_______________________________________________
City:______________ Province:_____________ Country:______________
Postal Code: ___________ Email: ________________________________
Telephone (Home):___________________  Fax (Home): _______________

Occupation:__________ Company Name:_____________  Title: _________
Company Street Address: _______________________________________
City:______________ Province:_____________ Country:______________
Postal Code: ___________ 
Telephone (Work):__________________ Fax (Work): _________________

Family Member - (Please make a copy if additional space needed)
Title: ___________ First Name: ______________ Last Name:__________
Occupation:__________ Company Name:_____________  Title: _________
Company Street Address: _______________________________________
City:______________ Province:_____________ Country:______________
Postal Code: ___________ Email: ________________________________
Telephone (Work):__________________ Fax (Work): _________________

Events you are interested in (choose all that apply)
     Business Speaker Brown Bag Lunch         Newsletter
     Donwakai                                 Hiking
     Cultural/Social Events                   Website/Internet Assistance
     Other

Are you interested in participating in any of the above organizing
committees?


Do you have any suggestions for us?