Membership Renewal Form - Central Canadian Federation of Mineral Societies

Central Canadian Federation of Mineralogical Societies
CCFMS c/o Treasurer, 629 Ester Street, Sudbury, ON P3E 5C6
http://www.ccfms.ca/ executiveofCCFMS@gmail.com

Annual CCFMS Membership Renewal Form
Strictly confidential except where indicated – English version

Please e-transfer to executiveofCCFMS@gmail.com

Section 1 – Membership Numbers as of Dec 31, 2025

Club Name *

Club Acronym

Name of Submitter *

Submitter's Email *

Membership Category and Counts

Number of Family Memberships# of Family Memberships – NOT number of people

Equals How Many People(families, essentially, are a minimum of 2 people – though families can be 3, 4, 5, and so on – this number can be approx)

* Family Memberships Amounts Due *$5.00 – Fee for each Family Membership

$

Number of Individual MembershipsIf your club has additional single membership categories, please list additional categories along with the numbers below.

Student Memberships

Life Memberships

Honorary Memberships

Courtesy Memberships

Name of Other Single Membership Types

Other Single Memberships Total

Total of Individual and All Other Single Memberships

* Individual and Other Single Memberships Fees Due *

$

Summary

Total Membership NumbersIncludes family household total, and all single memberships total

* Total Fees Due *Total Fees for Family, Individual and Other Memberships

$

Section 2 – Club Contact Public Information

Website

Facebook

Section 3 – Club Board, Executive, Council Members Contact Information

For internal use only amongst CCFMS Board and CCFMS Clubs

Board of Directors

President Name

Phone

Email Address

Vice-President Name

Phone

Email Address

Past President Name

Phone

Email Address

Secretary Name

Phone

Email Address

Treasurer Name

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Director Name

Role or Responsibility

Phone

Email Address

Other Leadership Positions Such as Coordinator, Lead

Name

Role or Responsibility

Phone

Email Address

Name

Role or Responsibility

Phone

Email Address

Name

Role or Responsibility

Phone

Email Address

Name

Role or Responsibility

Phone

Email Address

Name

Role or Responsibility

Phone

Email Address

CCFMS Representative (person who attends and votes at CCFMS AGM)

Phone

Email Address

Please share any other information about your club such as challenges or upcoming plans (This is strictly to better service your club)

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