CPOs Mess - Retired Associate Application FormCFB ESQUIMALT CHIEF

            AND PETTY OFFICERS’ MESS

            RETIRED ASSOCIATE MEMBERSHIP APPLICATION FORM

      CHIEF AND PETTY OFFICER’S MESS

      CFB ESQUIMALT

      PO BOX 17000 STN FORCES

      VICTORIA, BC V9A 7N2

      Memberships commence on 1 April of the current year and expire on the last

      day of March, the following year. The annual subscription fee is $206.44.

      All applications must be accompanied with proof of service as a member of

      the Canadian Armed Forces (RCN / Canadian Army / RCAF), in the rank of

      Senior Non-Commissioned Member

      (C&PO / WO or SGT)

      Personal Information (Please PRINT)

      Name: ____________________________________________________________

      Address: __________________________________________________________

      City: ____________________ Province: ________________________

      Postal Code: _____________ Home Telephone #: ________________

      Employer Information (Please PRINT)

      Name: ____________________________________________________________

      Address: __________________________________________________________

      Occupation/Position: _____________ Work Telephone # _________________

      COMMITTEE ACTION

      Date received: ______________

      APPROVED/NOT APPROVED Date: ______________________ Meeting MIN#: _________

      Ratified at General Mess Meeting Date: _________________ Meeting MIN#:

      _________

      Payment – Date: __________________ Receipt ________________