IMPORTANT: Check here to❑ Have your name and mailing address appear on Costco’s mailing list and receive information about promotions,

products and services, such as The Costco Connection magazine and coupon programs from Costco, regarding Costco, its affiliates, including Costco Wholesale Corporation (Costco and its affiliates are referred to collectively as the “Costco Affiliates”), and selected partners.

❑ Receive emails and other commercial electronic messages including promotions, special offers and other information from Costco, regarding Costco Affiliates and selected partners. Note that you may unsubscribe from receiving commercial electronic messages at anytime by following the “unsubscribe” link provided in commercial electronic messages received from Costco.

PLEASE PRINT

Primary Member’s Last Name Primary Member’s First Name

Type of ID (required to confirm your age, identity and address)** Date of Birth

Spouse’s* Last Name Spouse’s First Name

Spouse’s Type of ID (required to confirm your age, identity and address)** Spouse’s Date of Birth

Home Address

City Province Postal Code

Home Phone Number Email Address

Correspondence: ❑ English ❑ French

**Name, address, year and month of birth and telephone number collected, used and retained for (1) fraud detection, (2) identi� cation purposes, (3) a credit check which may be conducted if you choose to pay by cheque and (4) the uses described in our Privacy Statement including sections 5, 7 and 12.

Membership Number

Primary Member’s Signature Date Spouse’s Signature Date

Method of Payment: ❑ Cheque ❑ Cash ❑ Debit Card ❑ Credit Card

For Internal Use Only

Awareness Code Authorized

62000

Your card is valid at any Costco Wholesale location in Canada, Australia, the U.S., Puerto Rico, Mexico, Korea, Japan, the United Kingdom and Taiwan.

†This offer is valid for a new Costco membershiponly and expires August 31, 2017.

*A Spouse refers to either a spouse or a family member 18 years of age or older living at the same address.

®: Registered trademark of Price Costco International, Inc. used under license.

5218-16

A special offer for your employees.

SPECIAL OFFER GOLD STAR MEMBERSHIP

Sign up for a Gold Star Membership today and receive a special gift.†

( )

MM/DD/YY MM/DD/YY

MM/YY

MM/YY

HOW TO JOIN1. Print and complete this membership application.

2. Bring the application to your nearest Costco.

3. A Gold Star Membership is $55 per year (plus applicable taxes) and includes a FREE Spouse* card.

4. You can also sign up online at Costco.ca using the Promo Code “GSWEB83” during the checkout process.

For more information about Costco, drop by a warehouse, call 1-800-463-3783 or visit Costco.ca.