Parksville Probus Club membership application
Membership Information is not shared outside of the Parksville Probus Club. Initiation fee is $20 and  membership dues are $30 for a total of $50  payable by e-transfer to  pvprobustreasurer@gmail.com or by cheque. For more information, please  contact our membership chair Harry Broersma at:    ProbusMembershipChair@gmail.com or phone 778-584-0909
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Surname *
Preferred first name to be used with fellow members and on name badge *
e-mail address *
Principal Phone (format 1112223333. 10 digits, no spaces) *
Secondary phone if you have one (format 1112223333. 10 digits, no spaces)
Address including postal code *
How did you hear about Probus?
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Pre-retirement profession
Interests
What sort of skills or experience would you like to share? 
Reason for joining Probus  *
What type of name badge would you prefer? *
My method of payment for the $50  initial joining fee ($30 for membership + $20 initiation fee) will be by either e-transfer or by a cheque sent to
Treasurer.  8116, Southwind Drive, Lantzville, V0R 2H0
Please select the method of your choice below.
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