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First name

Last name

Street address

Street address line 2

City

Post code

Phone number

Email address

Membership type

Individual ($20)
Double/Family ($30)
Corporate ($30)

Donation

$20
$50
$100
Other

Other donation amount ($)

Total payment amount ($)

I would like a receipt for my donation

I would like a receipt for my donation

Bank deposits

Please make payment to account 03-0518-0205713-00 and enter your name and "membership" or "donation" in the reference fields.

Comments

My comments