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
EMAIL TO:
Please Interact your payment to:
susan_gibson@rogers.com


Top