The Whitby Historical Society Membership & Volunteer Application Form -2007
museum@whitbyhistoricalsociety.com 905 556 9822 www.whitbyhistoricalsociety.com
Welcome and thank you for your interest in becoming a member and volunteering with the Whitby Historical Society and Whitby History Museum & Children’s Centre. Your application information is confidential.
Contact Information
Name_________________________________________________________________________________
Address_______________________________________________________________________________
City________________________________________________________________________________
Postal
Code________________________________________________________________________
Home Phone_____________________________________________________________________
Work/Alternate Phone___________________________________________________________
E-Mail Address___________________________________________________________________
Availability to Volunteer
....at the Whitby History Museum & Children's Centre or location of special events.
Your Interests
Special Skills or Qualifications
Previous Volunteer Experience
Have you reached the age of magority?
Person to Notify in Case of Emergency
Name
Street Address
City & Postal code
Phone
Membership Fees: Jan. to Dec.
Single $10.00 - Family $15.00 – Senior $5.00 – Corporate - $40.00 Donations Voluntary__________ Amount Enclosed __________________________________________________ Agreement and Signature
Name (please print) ________________________________
Signature______________________________________
Date__________________________________________
By signing and submitting this application, I affirm that the facts set forth in it are true and complete. I offer my time as a volunteer with a clear understanding that there will be no monetary compensation from the Whitby Historical Society for hours worked. It is understood that, although volunteering is appreciated, there is no obligation to volunteer as a member of Whitby Historical Society. I agree to hold Whitby Historical Society free of any and all Liability.
Whitby Historical Society Policy:
It is the policy of this Society to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in volunteering with us.
Please return to Whitby Historical Society 123 Brock Street South Whitby, Ontario L1N 4J9