MEMBERSHIP
APPLICATION FOR FOW CANADA AND/OR CASH DONATION
Yes, I would like to improve the life-style of needy ostomates
by applying for the following membership and/or giving the
following cash donation.
Individual: $25.00 ______
Individual Patron: $45.00 _______
Corporate: $100.00 ______
Corporate Patron: $250.00 _______
Chapter, Group or Association: $1.00 per member (maximum of
150.00) _______
Please accept my donation of: $ ____________
Name: _________________________
Street: _________________________
City: _________________ Prov.: ______
P.C.: ______________
E-mail address: _________________________________
Official receipts for tax
purposes are issued
Please make cheque or money order payable to:
FOW Canada
c/o 19 Stonehedge Park
Ottawa, ON K2H 8Z3
|
