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CFUW
/ SARNIA LAMBTON ANNUAL
MEMBERSHIP APPLICATION FORM 2009-2010 If
you are a returning member with no changes, please fill in your name. If
you have any changes to make from last year, please fill in just the changes
below. NAME: __________________________________________________________________ ADDRESS: _______________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ PHONE: Residence:___________________ Business: _______________________ Email: ____________________________________________________________________ DEGREES: ________________________________________________________________ UNIVERSITY (UNIVERSITIES): ______________________________________________ _________________________________________________________________________ MEMBERSHIP FEE: $90.00 (All members) Date sent: ______________ A $25.00 donation to the Bursary Fund is suggested in lieu of an annual fundraising event. An official receipt will be issued. |
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Please mail your form and cheque to: Jane Anema 2750 Sandfield Crescent, Bright's Grove, Ontario N0N 1C0 |
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