Kuala LumpurWushu Canada
Confederation of Canadian Wushu Organizations
2370 Midland Ave. Unit B22-25, Scarborough, Ontario, M1S 5C6
Tel: 416.321.5913 Fax: 416.321.5068
website: www.wushucanada.com Email: info@wushucanada.com
CCWO Individual Membership Form - FORM 1B
Name: _______________________________________________ DOB MM/DD/YY: ____________
Address: _____________________________________________________________________________
Province: ___________________ City: ______________________ Postal Code: ________________
Gender: Male / Female (Circle one)
Telephone: _____________________Email: ________________________________________
Type of Membership: Recreational Athlete _____ Competitive Athlete _____
CCWO Class B Member $20.00 CCWO Class A Member $50.00
Coach Member _____
CCWO Class F G Member $50.00
General Member _____ Judge Member _____
CCWO Class K Member $20.00 CCWO Class C Member $20.00
Junior Wushu Development Program Coach Member _____
CCWO Class I Member $100.00
Please circle appropriate Class of membership.
Details available at www.wushucanada.com/membership.html
If unsure of Class please leave blank or contact CCWO representative
Authorized Regional Director's Signature: __________________________________
Applicant Signature: _________________________________
Administration Use: Membership Number: ______________________
Application Date: MM/DD/YY _______________
Renewal Year: 06 07 08 09 10 11 12 13 14 15
CCWO Organization Membership Form - FORM 1C
Non-Profit Corporate Name: __________________________________________________________
For-Profit Corporate Name: ___________________________________________________________
Address: __________________________________________________________________________
Province: ___________________ City: ______________________ Postal Code: ________________
Date of Incorporation (MM/DD/YY): __________________ Corporate Number: ______________________
Telephone: ____________________Email: ________________________________________
Website: _________________________ Contact: ______________________________
Type of Membership: Non-Profit Organization _____ Provisional Organization _____
Voting Member Non-Voting Member
CCWO Class L Member $300.00 CCWO Class M Member $0.00
Club/School Member _____ Affiliate Member _____
Voting Member Non-Voting Member
CCWO Class O Member $100.00 CCWO Associate Member $0.00
Please check appropriate Class of membership.
Details available at www.wushucanada.com/membership.html
Name of Authorized Signature: ______________________________ Title: ______________________
Authorized Applicant Signature: _________________________________
Please note to attach copy of corporation papers and a current registered list of Directors and Members
indicating membership status and contact information. Contact CCWO representative for details and
further requirements.
Administration Use: Membership Number: ______________________
Application Date: MM/DD/YY _______________
Renewal Year: 06 07 08 09 10 11 12 13 14 15