KAPLAZA Cooperative

(MHHS Health & Skilled Workers Cooperative)

Membership Registration Form

$5 annual membership fee. Members entitled to discounts from Cooprun businesses and free workshops. $100 per share. Only members can invest and receive dividends from profits of Coop-run businesses. Members can invest in a maximum of 20 shares.
I wish to become a member of the MHHS Health & Skilled Workers Cooperative. Yes

Personal Information
Title Mr.Mrs.Ms. Apt./Suite No. Province First Name/s (Include initials if applicable) City Home Phone No. Surname Postal Code Mobile Phone No.

Street Email

Status In Canada Temporary Worker

Permanent Resident

Citizen

Immigration program used to immigrate to Canada (e.g. Live-in care-giver, FSW, PNP): _______________________

Membership Shares and Fees

Membership Fees Annual - $5.00/year Lifetime - $25.00 Membership Shares ($100/share) Number of shares requested: __________ (Maximum of 20 shares) Total value of shares requested: $_______________

Payment Details
Select Mode of Payment Please make cheque payable to MHHS Health & Skilled Workers Cooperative Make payment at nearest Vancity Branch. Deposit to account of MHHS Health & Skilled Workers Cooperative and ask for a copy of the transaction. Account Number: 522318. Branch No. 7

______________________________ Signature

___________________ Date

Sign Up Instructions
1. Ilakip ang "cheque or deposit slip"/transaction receipt sa Vancity kasama ng form na ito na kumpleto ang mga " fields" at photocopy ng inyong ID. 2. Maaring i-mail sa MHHS Health & Skilled Workers Coop sa 4221 Fraser St., Vancouver, V5V4G1 o personal na dalhin sa address na nakasaad. 3. Makikipag-ugnayan sa inyo ang isang miyembro ng membership committee upang ibigay ang inyong membership number matapos suriin ang inyong aplikasyon. 4. For inquiries, please call 778.317.5300 or 604.620.7168 or visit our Kaplaza Coop FaceBook page

Facilitating Shared Wealth

Join the fastest growing organization in B.C. Open to care-givers, temporary workers and foreign skilled workers