Canadian Peregrine Foundation
MEMBERSHIP APPLICATION
Please print out and complete this form, and mail it to the address below, accompanied by a cheque payable to the Canadian Peregrine Foundation:
The Canadian Peregrine Foundation
25 Crouse Road, Suite #20
Toronto, ON
M1R 5P8
Canada
CPF MEMBERSHIP
(includes: a personalized membership card, a CPF member's badge, and a 10% discount on items from the CPF Gift Shop)
| o Single ($30 CDN / $30 US) | o
Family ($40 CDN / $40 US) (includes a second CPF badge) |
o Yes, I would like to make a supplementary donation of:
o $10 o $25 o $50 o $____
to help support the Canadian Peregrine Foundation's conservation efforts
| Your address:
Name: __________________________________________________________ Address: _______________________________________________________ ________________________________________________________________ City: __________________________________________________________ Province/State: ________________________________________________ Postal/Zip Code: _______________________________________________ Telephone: (____)_______________________________________________ E-mail: ________________________________________________________ |
Recipient's address: (if
different)
Name: ___________________________________________________________ Address: ________________________________________________________ _________________________________________________________________ City: ___________________________________________________________ Province/State: _________________________________________________ Postal/Zip Code: ________________________________________________ Telephone: (____)________________________________________________ E-mail: _________________________________________________________ |
____ check here to request a tax receipt (Canadian residents only)