Civitan International Foundation of Canada
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Application For Membership
MEMBERHIP
PRIVATE
($10.00 minimum initial donation)
CLUB OR CORPORATE MEMBER
($100.00 minimum initiation, $25.00 minimum annual donation)
GOVERNOR'S COUNCIL (Minimum donation of $100 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
18 Willow Crescent
Brechin, ON L0K 1B0
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Copyright © 2008
Civitan International Foundation of Canada
