Civitan International Foundation of Canada

Application For Membership

MEMBERSHIP
PRIVATE
($10.00 minimum annual donation)
CLUB OR CORPORATE MEMBER
  ($100.00 minimum initiation, $25.00 minimum annual donation)
GOVERNOR'S COUNCIL (Minimum donation of $100.00 annually)
I \ we wish to become a member of the Civitan International Foundation of Canada .
APPLICATION
Initiation Donation $
(to be mailed)
First Name:
Last Name:
E-mail:
Address:
City:
Province/State:
Postal Code:
Country
Date:
 
MAIL TO:
Please mail your cheque to:
Civitan International Foundation of Canada
52 Boullee Street
London, ON N5Y 1T6

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