Title

First Name *

Last Name *

Company Name *

Preferred Telephone *

Extension

Email Address *

Enter the name of any other club of which you are a member

How did you hear about the Rideau Club? *

To be considered for membership, a prospective member must be Proposed and Seconded, and provide two letters of Reference by current Members of the Rideau Club. If you do not know a Member the Club will make an introduction.

Do you know a Rideau Club member? *  Yes No