The Singles Mosaic

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	Membership Information Please enter required * information.
* Type	New Membership Renewal
* First Name
* Last Name
* Address
* City
* Province
* Postal Code
* Home Phone
Work Phone
FAX
Email Address
Occupation
Food Allergies ?
	Event Suggestions Got any ideas for future events? Let us know! Please try to provide us with as much information as possible. (eg. places, addresses, phone numbers?) VIP Club I would be interested in being on the following committee(s): Ambassador Assistant How would you like to pay for your Membership? I will send a cheque. Please call me for my Credit Card number. I will pay at the next Networking event. Membership Conditions Please read the following conditions of registration carefully: 1. I confirm that I am single, seperated, divorced or widowed. 2. Membership will cost me $50.00 Annually. 3. Refunds for events will be issued only if your cancellation is received seven (7) days prior to the event. Non-refundable partial payments may be required at times and will be specified as such in advance. 4. The Singles' Mosaic does not take any responsibility for lost or stolen articles during any event, although we do have a lost and found. 5. To ensure a safe and enjoyable social environment for all members, the Singles' Mosaic reserves the right to rescind membership for socially unacceptable or unethical behaviour, as determined by the club management. 6. The right to cancel or reschedule events due to inclement weather or insufficient registration, with refunds to the registrants, will occur when applicable. 7. The Singles' Mosaic shall not be liable for any damages arising from personal injuries sustained by a member or guest while in attendance at any event. Members attend at their own risk and forever release and discharge the Singles' Mosaic and it's Director from all and any claims, demands, rights of action or causes of action, present or future, anticipated or anticipate arising from the loss, damage, injury or death. 8. Forms of payment for membership and events are Cash, Cheque, Visa, or Mastercard.
	I have read the above and agree to abide by these conditions.*


	The Singles Mosaic Phone: (905) 333-4498 or (888) 334-4449 Events Hotline: (905) 333-9149 \| Fax: (905) 333-4992 E-mail: singles.mosaic@cogeco.ca