Tiger Watch Registration Form

Tiger Watch
1903-13383 108th Ave.
Surrey, BC V3T 5T6
(604)583-8729

DATE:  __________

NAME:  ________________________

COMPANY:  ___________________________________________

POSITION / TITLE:  _____________________________________

ADDRESS:  ___________________________________________

CITY:  _________________  PROVINCE / STATE:  __________  POSTAL CODE / ZIP:  ______________

PHONE:  __________________  FAX:  __________________  

EMAIL:  ___________________________

Please indicate which annual membership you are applying for:

(Billed in Canadian dollars; $1 US = approx. $1.60 CDN. GST =7%)

[   ] Individual - Introductory Rate!   $80.00 + GST per year

[   ] Corporate (includes 3 employees)   $250.00 + GST per year

[   ] Non-Profit (ask to see if your organization qualifies to have the fee waived) $150.00 + GST per year

Payment Method (Please circle):

Cash / Cheque     VISA / Mastercard / AMEX

****THE FOLLOWING INFORMATION IS STRICTLY CONFIDENTIAL****

VISA / M/C OR AMEX #:  ________________________   EXP. DATE:  __________

NAME (as it appears on the card):  ____________________

SIGNATURE:  ____________________________

VISA / MasterCard / AMEX orders can be faxed to (604) 583-8749

Please make cheques payable to:

Tiger Watch
C/O Caesi Bevis, Executive Director
1903-13383 108th Ave., Surrey, BC V3T 5T6
Phone: (604) 583-8729

***A credit card receipt will be provided upon request. Your canceled cheque is your receipt.***