WORLD FEDERALIST MOVEMENT - CANADA
Membership and Donation Form

Yes, I support the World Federalist Movement - Canada.

My membership payment is enclosed:

Membership Rates:      o $15 Limited Income      o $40 Individual    

o $60  Household o $150 Contributor

Membership payments are payable to       ‘World Federalist Movement – Canada’ and are not tax creditable.

To receive a tax credit, make donation payable to
‘World Federalist Foundation’(Char. Reg.123998957RR0001).

Donation Amount:   $ . . . . . . . . . . . 

Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City: . . . . . . . . . . . . . . . . . . . . . . .  Postal  Code:. . . . . . . . . . . . . . . .

                E-mail address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

        Telephone: . . . . . . . . . . . . . . . . . . . . . .

     Your special skills or interests: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bring to a branch meeting or print and mail this form with your cheque to:

World Federalist Movement - Canada, 207-145 Spruce St., Ottawa, K1R 6P1

o Please tick if you would like information on nearest branch activities.