Membership Application & Share Subscription Form

Please fill out this form and click submit.

Personal Information

Name

This address will receive a confirmation email

Phone

Gender

Please select one option.

Male Female

Date of Birth

Residential Address

Address

Country

Employment Details

Name of Employer

Nature of Business

Role Occupied

Employer's Address

Next of Kin Information

First Name

Last Name

Relationship

Phone

This address will receive a confirmation email

Address

Country

Where you referred by an exisiting Cooperative Member?

Please select one option.

Yes No

If yes, please enter the member's referral ID

Membership Fees (CAD$) - this is a compulsory fee

Please select all that apply.

20 (Non-refundable fee)

Members are enjoined to make a minimum contribution of $200 Nominal Shares to start enjoying the benefits of joining the Cooperative

Nominal Shares - $1 par share -(CAD$)

Please select one option.

200 (Min) 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2900 2900 3000 3100 3200 3300 3400 3500 3600 3700 3800 3900 4000

Preferential Shares - $4 par share -(CAD$)

Please select one option.

N/A 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300 2400 2500 2600 2700 2800 2900 3000 3100 3200 3300 3400 3500 3600 3700 3800 3900 4000

All payments must be made via Interac ONLY to accounts@movcoop.com

Check box below to Consent

I hereby apply to become a member of the MOV Multi-Stakeholder Cooperative Ltd. I declare that the information given above is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of the Cooperative as set out in its bylaws.

Please select all that apply.

I consent

Description

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Membership Application & Share Subscription Form

Description

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