Membership Application For FOW Canada And/Or Cash Donation
Yes, I would like to improve the quality of life of needy ostomates by applying for the following membership and/or giving the following cash donation.
Individual: $30.00 ______ Individual Patron: $50.00 _______
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.: ______
Postal Code: ______________
Phone: __________________
E-mail address: _________________________________
Official receipts for tax purposes are issued
Please make cheque or money order payable to FOW Canada
And mail to:
FOWC
c/o Lorrie Pismenny – Secretary
1101-80 Snow Street
Winnipeg, MB R3T 0P8
