2008-07 - Hang Gliding and Paragliding Association of Canada

Hang Gliding and Paragliding Association of Canada
5 Millennium
7 Windal
Dr. • Stratford,
Ave., Toronto,
P.E.I.
ON
• C1B
M9N
2H2
2C2
Phone / Fax: (416) 243-0469 Email: admin@hpac.ca
E-mail: bm@hpac.ca
APPLICATION FOR MEMBERSHIP
HPAC and Provincial 1 Association Membership Fees
Includes $3 Million third-party liability insurance, valid Canada wide, and a magazine (see below depending on your province).
FULL MEMBER: Choose ONE of A, B, C or D OPTIONS:
A. Ontario, NWT, out-of-Canada residents (includes
Air Magazine) $0 provincial fee
B. Manitoba, Nunavut (includes Air Magazine)
$25 provincial fee
C. Atlantic Provinces, Saskatchewan, Alberta, British
Columbia, Yukon (includes Air Magazine)
$15 provincial fee
$125
$150
Hang Gliding and Paragliding Online Contest (HOLC)
Season-long event, points don't count for National Ranking
Hang Gliding and Paragliding Online (HOLC)
Season-long event, points count for National Ranking
$140 Subscription to AIR Magazine for non-HPAC members $30
D. Quebec (includes SurVol Magazine) $43 prov. fee $150 Subscription to AIR Magazine for HPAC members $18
Total of Membership Fees (A, B, C or D): Total of Optional Fees :
TOTAL SUBMITTED TO HPAC (Membership + Optional fees):
$12.50
$17.50
Subscription to SURVOL Magazine for HPAC members $18
(Subscription to SURVOL Magazine for non-HPAC members
is available for $25 directly from AQVL.qc.ca )
Cross Country Magazine
USA Publication Subscription, 6 issues per year, CAD
Optional airmail delivery, CAD
New Member ( Yes No ) Check appropriate (HG Pilot PG Pilot )
HPAC/ACVL Membership # (required if you are currently or have previously been a member):
Name: ________ Male Female
Address: __________________________________________City: __________________
Province: _______ Postal Code: ____________ Country: ____________
*
$60
$20
Club or School Affiliation:
___________________
Phone Home: ( ) - Work: ( ) - Cell: ( ) -
Date of Birth: (day) (month) (year) E-mail: ______________
Medic Alert: ____________2 Meter Radio Call Sign: _________________
In Case of EMERGENCY contact: ___________________ Relationship: ___________
Address: ____________________City: ____________
Province: ________________Postal Code: ____________ Country: ____________
Phone H: ( ) - Work: ( ) - _
I wish this information to remain confidential—i.e. not made available on the list distributed to members :
It is MANDATORY to carry third-party liability insurance to fly most sites in Canada. HPAC/ACVL Liability Insurance is only available
to members of the HPAC/ACVL. If you are applying for membership please complete the following:
Did you have an accident or incident in the past year that was not reported (Yes No )
Receive paper version of AIR (Yes No ) OR receive paper version of SurVol (Yes No )
I ACKNOWLEDGE THAT THIS FORM IS AN APPLICATION FOR LIABILITY INSURANCE
AND THAT ALL THE INFORMATION GIVEN ABOVE IS CORRECT.
Dated: _____ Signature:_____________________________________________________________
1
The HPAC/ACVL collects Provincial Membership fees on behalf of Provincial Associations. This mandatory fee is set by Provincial
Associations.