name_____________________________________

address__________________________________

city ________________________ prov ______

postal code _____________

phone ___________________________________

fax _____________________________________

e-mail __________________________________

Full Member 1 year - $5 ____

Student Member 1 year - $2 ____

Family Member 1 year - $10 ____

Five Year Membership - $20 ____

membership renewal    yes ____ no ____

I would like to volunteer    yes ____ no ____

Mail me stuff    yes ____ no ____

I would like to donate an additional $ ________
and receive a charitable tax receipt.