EMS Membership Application – Esquimalt Men's Shed

About you

First Name *

Last Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal code *

Country *

Phone *

Email Address *

InterestsThis field allows applicants to enter the types of activities in which they are interested,

Mobility IssuesThis field allows applicants to describe any mobility issues they may have. Listing these issues will in no way affect an applicant’s acceptance as a member.

What are your reasons for choosing Esquimalt Men’s Shed?

Socialising

Community Projects

OtherOther

Emergency Contact

First Name *

Last Name *

Relationship *Please indicate the relationship you have with this person (eg. Spouse, Partner, etc.).

Phone *

More About You

What interests and skills will you bring to our shed?

In what activities would you like our shed to participate?

Do you have a preference for meeting type, location, and time?

Comments

Date *