*When purchasing multiple memberships:Please select the appropriate quantity and input the first and last names of each member voting to protect Delta Hospice Society.
1. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ Province Zip/ Postal Code 2. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ Province Zip/ Postal Code 3. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ Province Zip/ Postal Code 4. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ Province Zip/ Postal Code 5. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code 6. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code 7. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code 8. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code 9. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code 10. First Name Last Name Email Area Code Phone Number Street Address Address Line 2 City State/ ProvinceZip/ Postal Code
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4631 Clarence Taylor Crescent, Delta, BC V4K 4L8 Phone: 604.948.0660 Fax: 604.948.0651
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