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MEMBERSHIP
APPLICATION
Vancouver Chapter United Ostomy Association
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| Membership
in the UOA of Canada is open to all persons interested in ostomy rehabilitation
and welfare. The following information is kept strictly confidential. |
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| Please
enroll me as a (check one) ____new ____renewal member of the Vancouver
chapter of the UOA. |
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| I
am enclosing my annual membership dues of $30.00, which I understand
is effective from the date application is received. I wish to make
an additional contribution of $ ______________, to support the programs
and activities of the United Ostomy association of Canada. Vancouver
chapter members receive the Vancouver Ostomy HighLife newsletter become
members of the UOA Canada, Inc. and receive the Ostomy Canada magazine.
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| Name
_______________________________________________ Phone ____________________ |
| Address _______________________________________________________________________ |
| City _________________________________
Postal Code ________________ Year of Birth ____ |
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| Type of surgery:
___ colostomy ____ Ileostomy ____Urostomy ___ Continent Ostomy _____ None |
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All additional
contributions are tax deductible. Please make cheque payable to the
UOA, Vancouver
Chapter
mail to: Arlene McInnis, 34 - 4055 Indian River Drive, North Vancouver,
BC V7G 2R7
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