DA STEWPID CANADIAN
MEMBERSHIP FORM

DA STEWPID CANADIAN
C/O  J. BOUDREAU
2393 FINCH AVENUE WEST
WESTON ON M9M 2W8

PLEASE FILL IN THE BLANKS THEN PRINT AND MAIL TO ADDRESS ABOVE

IF  YOU NEED INFO, PLEASE ASK
EMAIL: [email protected]

LAST NAME:

FIRST NAME:

RETURN

TO

MAIN PAGE

ADDRESS:

HOUSE/UNIT #

PO BOX #

CITY

PROV/STATE:

POSTAL/ZIP:

COUNTRY:

FAX:

EMAIL:

HOMEPAGE/URL:

INCLOSED IS A CHEQUE OR MONEY ORDER FOR $25 FOR ONE YEAR MEMBERSHIP.

I AM NOT INTERESTED IN BECOMING A MEMBER,  I AM SENDING A DONATION TO HELP THE CANADIAN CAUSE.

I AM ENCLOSING A SELF ADDRESSED, STAMPED ENVELOPE FOR MORE INFORMATION