Membership Application

    Community Power Northumberland Co-operative Inc.

    Ontario Corp. #1811854

    Surname:First Name:Initial:

    Street Address*: Town/City*

    ProvincePostal Code:

    Home Telephone: Fax:

    Work Telephone:Cell:

    E-mail Address*: Are you a property owner in Northumberland County for at least two years? YesNo

    Community Power Northumberland (CPN) Membership Agreement

    It is my understanding that I am not a member with voting privileges until my membership has been accepted by the Board of Directors of the Co-operative at the next regular CPN Board Meeting held following receipt of this application.

    I acknowledge that I am a resident of the Province of Ontario and that I am eligible for membership in the Co- operative as set out in the Cooperative Corporations Act (Ontario) and in the By-laws of the Community Power Northumberland Co-operative Inc.

    Upon submitting this form, I agree to print the copy I receive via email, sign it, and mail the completed and signed Membership Application form along with a cheque for $25 made payable to: “Community Power Northumberland Co-operative Inc.” at Community Power Northumberland Co-operative Inc., 154 Stuart St, Cobourg, On., K9A 2Y2

    Signature:___________________________________________________ Date (YYYY-MM-DD):