Brockville ME Association

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Join the Brockville M.E. Association

To join the Brockville M.E. Association and receive the monthly newsletter, please complete the following membership form. There is no compulsory membership fee, however, to help offset the costs of publishing and distributing the newsletter, a donation of $15 or more is appreciated.

Make cheques payable to Brockville M.E. Association and mail your application to our office. We issue a receipt for income tax purposes to gratefully acknowledge all donations.

Registered Charitable Organization
Charitable BN No. 89247 5773 RR001

A United Way - Centraide Member Agency

Name: ______________________________ Phone: ___________

Address: ______________________________

City/Town: ______________________________ Prov.: ________________

Postal Code: __________________ Email: _______________________

I have enclosed a donation of $15 _____ $25 _____ Other: _____

I am unable to donate at this time but would like to receive the newsletter _____