Canadian Tamil Youth Alliance

Application for Group Membership

ORGANIZATIONAL INFORMATION:
Name of Organization
Address
Phone #	Fax #
Email	Website

PERSONAL INFORMATION:
First Name	Last Name	Title
Address (if different from above)
Phone # (if different from above)	Fax # (if different from above)
Email (if different from above)

ORGANIZATION'S AREA OF INTEREST:
Arts / Culture
Athletics
Education / Career Development
Human Rights Advocacy
Tamil Nation Development
Other:

Please indicate number of members of your organization:

ORGANIZATION'S ACTIVITIES::

Please list any affiliations with other organizations (Coalitions/Alliance/Umbrella with Tamil or non-Tamil):

MEMBERSHIP INFORMATION:	New Membership Membership Renewal
Membership Options:	5-50 members - $25 51-100 members - $50 101 and above - $75
Payment Method:	Master Card VISA

MEMBERSHIP CONSENT INFORMATION

On behalf of the organization I, declare having read and understood the Code of Ethics in its entirety and hereby consent to participate acknowledging all the foregoing.