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Canadian Peregrine Foundation - Membership Application

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)