CSEA Inc.

 Co-op Services for Energy Alternatives

 R R # 1,   Wilsonville, ON     N0E 1Z0     Canada

 Phone: 519 446 3074  email:  This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

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Membership Application

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I understand the goals and I agree with the benefits outlined and I wish to enrol as a Member. I also agree that if my membership application is accepted and I am admitted as a Member by the CSEA Inc.'s Board of Directors, I will abide by all the by-laws and policies as set out by the Board concerning the Membership.  I am also aware that, as a Member, I will be eligible to register with the Producer Program.

 A membership fee of $530.00 dollars, which includes 6% G.S.T. (Business # 851999722), is required and it has been estimated that no more than 1000 members shall be enrolled; in order to ensure the Membership goals can be realized. 

Please make all cheques payable to CSEA Inc.

In addition, it is acknowledged that, in the event that CSEA Inc. determines that insufficient members are enrolled to ensure the success of its defined mission statement, all monies collected, minus appropriate business administrative expenses, as determined by CSEA Inc.'s Board of Directors, shall be returned to each member on a pro-rata basis.   

Signed ________________________________ 

Date  _____________________

Witness _______________________________

Additional Information (Please Print)

Name  _______________________________________

Address______________________________________

City/Town ____________________Province_________

Postal Code___________________

911#________      Lot and Concession______________

Phone   (____)______-________

Fax        (____)______-________

E-Mail ________________________________________