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Fraser Valley Naturist Club
Membership Application Form
Membership #: ______
Please fill in fields in color/Bold, all other fields are Optional

Personal Information

Surname: Full Christian Name Date of Birth {D/MM/YYYY}
Surname:____________________ Full Name:_______________________ Date of Birth:_________
Common Name: ______________ Occupation:_________________
Surname:____________________ Full Name:_______________________ Date of Birth:_________
Common Name: ______________ Occupation:_________________

Address / Contact Information

Home Address: ____________________________________________________________
City: _______________ Prov/Terr/State:___________ Country: _______________ Postal Code:______________

If your Postal Address is different than above, please fill in the below:

Postal Address: ____________________________________________________________
City: _______________ Prov/Terr/State:___________ Country: _______________ Postal Code:______________

Home #:________________ Cell #: __________________ E-Mail Address:_______________________________________
Pager #: ________________ Fax #: __________________ E-Mail Address 2: _____________________________________

Do We have your permission to list your name / phone / email / address on a general membership contact list?
Please Check the Appropriate Spaces if you are giving permission: ......What is your preferred method of Communication?
Phone:___ Cell:____ E-Mail: ______ Address: ________ .. .............. ______________________________________

If no permission is given, only the FVNC Board of Directors will have access to this info.

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All the information Below will be kept private and only FVNC Board of Directors will have access:

Activity Suggestions / Talents / Hobbies

Please check the list below to highlight your suggestions / talents / hobbies.
If a couple is filling this form out and the below is different for each person, please use the following coding: M = Male, F = Female
Activity Preparation:____ Cooking Skills:___ BBQ / Picnics: ____ Swimming:___
Activity Leadership: ____ Music: ___ Hot springs Trips: ____ Darts:____
Activity Help: ____ Artwork: ____ Visit Other Clubs:____ Hot Tub Parties: ____
Committee Work:____ Computer Skills: ____ Boat Trips: ____ Bowling: ____
Phone Committee: ____ Bus Trips:____ Sailing: ____
Giving Rides: ____ House Parties: ____ Dances: ____
Do you Need a Ride:___ Potluck Parties:____ Tennis: ____
Nude Events: ____ Hiking / Trekking: ____
Other Suggestions: ____________________________________ Games Nights: ____ Horse Riding:____
____________________________________ Wreck Beach Trips: ____ Badminton: ____
____________________________________ Volleyball: ____
Other Skills: _____________________________________________________________________________________________

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Please List any children / dependants
Please list any Child 17 years or under below. THEIR MEMBERSHIPS ARE FREE. Any youth older than 18 must fill in their own application.

Childs Name: _____________ Date of Birth:__________ Childs Name: _____________ Date of Birth:__________
Childs Name: _____________ Date of Birth:__________ Childs Name: _____________ Date of Birth:__________

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Emergency Contact / Survey
Please provide the name and phone of at least one person, to be contacted on your behalf, in the case of an Emergency.
Contact Name: ____________________________ Emergency Phone: __________________ Relation:______________

Do you have any Space where FVNC can use for activities? Yes: _____ No: ____ Where: ______________________________________

How Did you hear about FVNC?
FVNC Member: ________ Newspaper Ad: _________ What Paper: _________________________________
FVNC Website: ________ Radio:_______ What Station: ________________________________
FCN: ________ TV: _______ What TV Station: _____________________________
WCANR: ________ Swim:_______ What Swim: _________________________________
AANR: _________ Word of Mouth:_________ Other Ad?: __________________________________
INF: __________ Phone Book: _________ ____________________________________
Website Ad: ________ What Website: _______________________________________________________________

What previous experience have you had with Social Nudism?: _______________________________________________
___________________________________________________________________
Do other members of your family or any of your friends practice social nudism? ________________________________________________________________________________________________

Have you ever had a criminal record? Yes:______ No:_____

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Membership

New to FVNC?: ______Renewing Membership?: ______ Have you been a member of a Naturist / Nudist Club before?: _____

FCN Member: _______ FCN #: ______________ FCN Expiry Date: _____________
AANR Member: ______ AANR / WCANR #: ________________ AANR Expiry Date: _____________ AANR Region: ____________
INF Member: _______ Other clubs: __________________________________________

New members must go through a screening process by our membership committee. Once approved, there will be a one year probation period (no voting privileges) before final approval.

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Payment Options

Registration Fees are as follows: Single / Student = $68.00; Couples / Families = $110.00
The Registration includes WCANR & AANR Dues.

Please check off the Appropriate Membership you are applying for:
Single: ____ Student: _____ Couple: _____ Family:____

I / We, the undersigned are applying for Membership in FVNC. I / We agree to abide by the Bylaws & Constitution of FVNC.

Signature: _____________________________________ Date of Application: ____________________ {d/mm/yyyy}
Signature: _____________________________________ Witness Signature: _______________________________

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Office Use Only
Paid By: ____________ Amount: __________
Notes: __________________________________________

FVNC Board Member Accepting Membership Application:

Date Accepted: ____________
FVNC Board Signature: __________________________

Revised May 15, 2009 

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