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):