Membership Form

           

Name _______________________________________________________

Organization ________________________________________________

Address _____________________________________________________

City __________________________Province_______________________

Phone (______)________________ Fax (______)____________________

Email________________________________________________________

Web site__________________________________________

          Membership Category

Individual / Family

community groups, agencies, small businesses

Public institutions and business

up to $5.00

$20.00

$50.00

To include a donation with your membership fee check one of the following:

$20.00

$50.00

$80.00

other $_______

 I would like my donation to be used for programs and services in the
community of _______________________ (optional).

 TOTAL CONTRIBUTION: $_________

Donations to CBAL are tax-deductible. Federal Registration # 866922610 RR0001
 
_______________________________________________________________________
Please Return this form to:
The Columbia Basin Alliance for Literacy
P.O. Box 2143
Invermere, BC  V0A 1K0
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