Membership Application

To: Museum at Campbell River, Box 70 Station A, Campbell River BC V9W 4Z9 [fax: (250) 286-0109]

Name: __________________________________________________

Address _________________________________________________

_______________________________________________________

Phone ____________________

E-mail ______________________

For family membership, list spouse and children's names:

Spouse ___________________________________

Children ____________________________________________________________

Please indicate membership category below and enclose payment indicated by cheque or credit card.

Visa MastercardCard # _______________________ Expiry _______________

Name on credit card ___________________________Signature __________________________

INDIVIDUAL 28.00 (HST included)
outside of Canada 30.00 Cdn.
FAMILY 39.20 (HST included)
outside of Canada 35.00 Cdn.
SENIOR (65+) 22.40 (HST included)
outside of Canada 25.00 Cdn

BUSINESS 44.00 (HST included)
outside of Canada 45.00 Cdn.