Membership

Membership Application For FOW Canada And/Or Cash Donation

Yes, I would like to improve the quality of life of needy ostomates by applying for the following membership and/or giving the following cash donation.

Individual:   $30.00    ______     Individual Patron:  $50.00   _______

Corporate: $100.00   ______     Corporate Patron: $250.00 _______

Chapter, Group or Association: $1.00 per member (maximum of 150.00)  _______

Please accept my donation of: $ ____________

Name:     _________________________

Street:     _________________________

City:  _________________  Prov.:  ______

Postal Code:       ______________

Phone:        __________________

E-mail address:  _________________________________

Official receipts for tax purposes are issued

Please make cheque or money order payable to:

FOW Canada
Suite 609, 344 Bloor St. W.,
Toronto, ON M5S 3A7

Leave a comment

Leave a comment

Your email address will not be published. Required fields are marked *

%d bloggers like this: