First Name ________________________ Last Name ________________________________
Street _________________________________________ Apartment/Unit # ______________
City ____________________ Province/State ________________ Country ________________
Postal/Zip Code ______________ Phone ___________________ Fax ___________________
E-mail ___________________________________
Membership
[ ] Group/Club Membership ($40) enclosed*
[ ] Family Membership ($30) enclosed*
[ ] Adult Membership ($20) enclosed*
* Please make cheques payable to the St. Clair Region Conservation Authority, our financial administrator.
Donor/Volunteer
[ ] Donor/Volunteer
[ ] $10 voluntary donation enclosed*(to cover printing and mailing,
speakers and hall rentals)
Active Participation
I am interested in participating on the following committee(s):
| [ ] Board (elected positions) [ ] Habitat Restoration [ ] Promotions [ ] Fish & Wildlife |
[ ] Habitat Protection [ ] Membership [ ] Agriculture [ ] Fundraising/Finances |
I am interested in participating in the following way(s):
| [ ] speaker organization [ ] organizing outings [ ] newsletter editing [ ] writing funding proposals [ ] legal assistance [ ] recording Board meeting minutes [ ] promotion [ ] world wide web management |
[ ] membership development [ ] corporate fundraising [ ] photographer [ ] Rondeau Bay Rejuvenation clean-up [ ] clipping local news articles from __________________ newspaper [ ] Other ___________________________ |
Please print and return this form to:
Rondeau Bay Watershed Rehabilitation Program, P.O. Box 1168,
Chatham, Ontario, Canada. N7M 5L8