Home > About Us > Membership Application Form

Thanks for your interest
in becoming a member!

Your support is appreciated!

Become a member is 3 easy steps... 1. Fill out this form.
2. Print this form.
3. Mail this form with your donation.

Name:
Address:
City: Postal Code:
Province: Telephone:

This is A New Membership
This is A Renewal Membership

$5.00 single/family Membership:
$ .00

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Your donation will help support the Vision and Goals of
Community Living Port Colborne - Wainfleet:
$ .00

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Notes:
Make your cheque or money order payable to: Community Living Port Colborne
Mail to:
Community Living Port Colborne - Wainfleet
100 McRae Ave.
Port Colborne, Ontario
L3K 2A8

Official Income Tax Receipts will be issued for all paid Memberships and Donations

© 2003 Community Living Port Colborne Wainfleet & DJPM