Complete the Form below to purchase a membership, parking pass or mailout newsletter A Membership, Newsletter, Parking Registration Membership Type:*New MemberRenewalVirtual Parking Pass* Annual Parking Pass $5.00 No Thank You Parking The cost of an annual parking pass for the Centre is $5.00 and is valid from January 1st to December 31st 2021. Note: Virtual Parking Passes take effect 24 hours (1 Business Day) after payment has been received.My Licence Plate Number is?* Please Note: To avoid a parking ticket, double check and ensure you have entered the correct vehicle licence plate number. Name* First Last Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email If you do not have an email address please leave blankHome Phone*Cell or Other PhoneEmergency Contact InformationEmergency Contact Name* First Last Emergency Contact Phone*Emergency Contact Relationship to You Consent* I have read and understood the Membership Release Clause Agreement for the St James Assiniboia 55+ CentreIn Consideration of my acceptance as a member, participant, and/or volunteer of the Centre, I do hold harmless the Centre, its Directors, Officers, and Personnel engaged in or volunteering to conduct the Centre's activities, from any and all liability for any claim, demand, suits or clauses of action growing out of or if any way attributable to any injuries, including death, damage or loss to me whatsoever, arising out of or connected with the conduct of the Centre's property or facilities.Media Release Consent Clause*I CONSENTI DO NOT CONSENTI hereby grant the St James Assiniboia 55+ Centre (SJA55+ Centre), its representatives, and authorized media partners the right to take photographs, videos, or audio recordings of me during programs, events, and activities organized or affiliated with the Organization. I understand and agree that these materials may be used in various forms of media, including but not limited to print, digital, social media, website content, promotional materials, and public reports, to support and promote the Organization’s mission. I acknowledge that I will not receive any compensation for the use of my image, voice, or likeness. I further waive any right to inspect or approve the final materials and release the Organization from any claims or liabilities arising from their use. If I do not wish to be included in media coverage, I understand that it is my responsibility to inform the Organization in writing prior to participation in any event or activity.How did you hear about us? friend radio ad newsletter Social Media Website Community Event Payment Options* Pay Online Pay at the Centre The "Pay at the Centre" option should only be selected when purchasing Membership, Parking options while in person at the St. James Assiniboia 55+ Centre. Note: Virtual Parking Passes take effect 24 hours (1 Business Day) after payment has been received.Payment Type* Cash Cheque Visa Mastercard Debit Other Credit Card*Card Details Cardholder Name Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Total $ 0.00 CAD CAPTCHA