Membership Form
First Name
*
Last Name
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Membership Type
*
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next
( X )
Individual
$
50.00
CAD
Dual
2 Memberships
$
75.00
CAD
Family
2 Adults + 2 Children
$
150.00
CAD
Student/Artist/Senior
$
40.00
CAD
Non-Profit and Community Groups
$
50.00
CAD
Friend
$
250.00
CAD
Associate
$
500.00
CAD
Affiliate
$
1,000.00
CAD
Advocate
$
1,500.00
CAD
Partner
$
2,500.00
CAD
Credit Card
Dual/Family Adult Membership Name
First Name
Last Name
Dual/Family Adult Membership Email
example@example.com
I would like to sign up for the Perkopolis discount program
*
Yes
No
Type of membership
*
New
Renewal
Submit
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