Membership Registration Form PCA Membership Registration Form Please complete the following to activate your PCA membership. Your payments will be processed via PayPal. The Parkdale Community Association respects the privacy of its members and shall not disclose, distribute or rent its e-mail subscriber news list to any third party, nor shall it permit anyone else to do so. Members will only be contacted for providing community-related information or volunteer opportunities they have indicated on this form. 5% GST included in membership price. GST # 10781-4949 Your Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* I agree that my contact information may be used for the sole purposes of community information provision or volunteer opportunities.* I agree. I do not agree. 1-Year PCA Membership*Your annual membership that grants you/your family access to PCA services. You will also be eligible to vote in the PCA's annual AGM if you are a resident of Parkdale. Prices include 5% GST.Family Membership - $ 26.25 CADSingle Membership - $ 21.00 CADSenior Membership - $ 5.25 CADHow many other members of your family (not including yourself) are over 18, and are therefore eligible to vote at the PCA AGM?Please enter a value between 0 and 5.Please enter the name of your first family member who is over 18 (not including you). First Last Please enter the name of your second family member who is over 18 (not including you). First Last Please enter the name of your third family member who is over 18 (not including you). First Last Please enter the name of your fourth family member who is over 18 (not including you). First Last Please enter the name of your fifth family member who is over 18 (not including you). First Last VolunteersThe Parkdale Community needs volunteers to continue to grow and thrive, and to enrich the community for everyone. Please indicate areas you would be interested in volunteering. A member of the PCA will be contacting you regarding your selection(s).AGM and Town HallsFinance and TreasurerChildren’s ActivitiesHoliday PartiesSpecial EventsFarmers MarketGarden CommitteeArts and Crafts FairEditorial PanelDelivery RoutesSkating RinkSoccerMembers’ AssistanceHandymanGeneral VolunteeringOther Skills or TalentsBoard of DirectorsMemberships/CanvasserPlanning & DevelopmentP&D Escarpment SubcommitteeP&D Heritage SubcommitteeP&D Traffic and Parking SubcommitteeP&D Tree Huggers SubcommitteeCasino and/or FundraisersGrants and DonationsFacilities RentalsMarketing & WebsiteTotal $ 0.00 CAD This iframe contains the logic required to handle AJAX powered Gravity Forms.