THRC Student Membership Purchase and Renewal

Contact Information

First Name

Last Name

Home Address

City/Town

Postal Code

Home Phone Number

Cell Phone Number

Email Address

THRC Membership Information

How did you hear about THRC?

If other, please specify

I agree that THRC may use this email address to contact me for renewals, information sharing, events, current issues, professional learning, late fines and overdue reminders, if applicable. I may unsubscribe at any time.

YesNo

Upload a photo of your valid Student ID

File types accepted: JPG, PNG, PDF. 4MB maximum file size.

Workplace Information (if applicable)

Name of Workplace

Work Address

City/Town

Postal Code

Phone Number

Liability Statements

I understand that I am responsible for any information borrowed from The Halton Resource Connection.

Yes

I understand that I am responsible for returning equipment to The Halton Resource Connection in the same condition that it was borrowed

Yes

I understand that I am financially responsible for damage done to equipment or fines incurred on overdue items. In the case of outstanding fees/fines I will pay in person or provide credit card information.

Yes

I understand that The Halton Resource Connection accepts no responsibility for injury caused by equipment borrowed.

Yes

Payment Information

THRC Annual Membership Type

Your credit card will be charged this amount

Name on Card

Billing Email

Card Number

CVV Code

Expiry Month

Expiry Year

Contact Information