TARA Membership Application Form

WARNING! This form should NOT be used with Internet Explorer

All sections marked with a * must be completed before submitting the form.

Title *

Last Name *
First Name * Middle Initials

Last name whilst at TRIUMF if different from above

Address *

City *

Province/State *

Country *

Postal/Zip Code *

Area Code and Phone Number *

Email Address *

Area Code and Cell Phone Number

Area Code and Fax Number

Employer (if TRIUMF, indicate which site) *

Primary Group you belonged to at TRIUMF *

First year at TRIUMF * Last Year at TRIUMF *

Would you like your information made available to other TARA members via the secure association website?
If so, please enable (check) the following options:

Address

Phone #

Email Address

Personal Information and Electronics Documentation Act (PIPEDA) 2000
All information included on this form will be added to TARA's Database and will be used for TARA purposes only. These purposes may include: sending out TARA publications, with information regarding benefits and services available, events and reunions, support programmes, projects and volunteer opportunities. You have the right to object to the use of your data for any of the purposes listed above.

Please select the appropriate option below:

I agree to my data being held for the above purposes

I do not wish my data to be used for any of the above purposes

I am interested in helping run TARA and/or helping with TARA events
I would like to volunteer for TRIUMF activities, eg. tour guide, events,

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