7/28/2019 MARS Membership Form

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Membership Application

Mountainaire Avian Rescue Society

6817 Headquarters Road

Courtenay BC V9J 1N2 Date of Application: _______________

Please find my cheque enclosed for MARS Annual Membership: (please check)

Fees: Individual $15 ____ Senior (60+)/Student $10 ____ Family $25 ____

Affliliate Membership $35.00 ____ Corporate Membership $250.00 ____

Or pay by credit card:

Visa or Mastercard number :

Expiry Date:

Name on card: ______________________________________

Total Amount: _______________

Signature: __________________________________________

Your Name:

Street Address

City,

Province/State

Postal/Zip Code

Phone Number:

E-mail Address:

All personal information will be kept confidential.

Receipts cannot be issued for Membership Fees