Canada Japan Society Of Ottawa

Membership Form

Name: ________________________________________________________

Address: ______ same as now listed or use address below:

________________________________________________________

________________________________________________________

Telephone: ______ same as now listed or use numbers below:

Home Phone: __________________________

Office Phone: ____________________________

E-mail address: ____________________________________________

Please check type of membership desired: New_____ or Renewal _____

_____ Individual ($15.00)

_____ Individual senior ($ 5.00)

_____ Family ($25.00)

_____ Student Visa or Work Holiday Visa (no charge). Visa expiry Month _________

If family membership, please list all other family members and indicate ages of children under 16:

__________________________________________________________

___________________________________________________________

___________________________________________________________

Our newsletters are available by e-mail! Please check if you would like to receive the e-mail versions instead of paper copies _________ (Photos of digital version are in colour)

Reminder and confirmation of attendance at monthly dinners (please check only one):

Contact me by e-mail: _____

Contact me by phone: _____

Do not contact me; I will contact CJSO when I wish to attend: ______

Please do not send cash by mail. Make your cheque or money order payable to

Canada Japan Society of Ottawa and mail it to:

CJSO Membership
P.O. Box 8260, Station T
Ottawa ON
K1G 3H7