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*First name |
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*Last Name |
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*Mailing address |
_________________________ |
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* City |
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* Province |
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* Postal code |
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* Phone |
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*Signature |
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Fax |
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E-mail |
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Membership |
| 1 year - $10 |
2 years - $20 |
3 years - $30 |
| 4 years - $40 |
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5 years - $50 |
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Make cheque payable to:
Dufferin-Caledon Conservative Party |
OR VISA & MASTERCARD
Card Number:
Expiry Date:
Signature: |
Donation: I would also like to make a
tax-deductible contribution
to the Dufferin-Caledon Conservative Party
in the amount of:
$____________(Dollar amount only please) |
Mail Cheques to:
Dufferin-Caledon Conservative Party
P.O. Box 436, Orangeville, On. L9W 5G2 |
Conditions of membership
- Canadian citizen or permanent resident of Canada
- Active support for the founding principles of
the Conservative Party of Canada
- At least 14 years of age
- Payment by applicant of required membership fee
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