Membership

 

Name:		Membership $:
Address:		Donation $:
		Total $:
City:	Prov:	Postal:

Phone:

Cell # :

eMail:

Membership - please check the length of membership you wish to purchase:

1 year - $10.00

2 year - $20.00

3 year - $30.00

5 year - $35.00

By attaching payment I certify that I meet these Conditions of Membership:

- I am a Canadian Citizen or a Permanent resident of Canada

- I actively support the founding principles of the CPC

- I am at least 14 years of age

Payment Method:

Cheque Enclosed

Credit Card

Credit Card Type:	Visa Master Card Amex
Name on Card:
Card Number:
Expiry Date: