Application for Annual Membership

Application for Annual Membership
Choose one:
Date

MonthDayYear
Date
Names
Maiden Name if applicable
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Phone number
Format: (000) 000-0000.
Yes, I wish to receive emails from the Society?
Number of years residing in Charleswood:
Annual Membership Fee options:
Annual Membership Fee options:

Payment instructions to e-transfer your membership fee:

Send to: treasurer@charleswoodhistoricalsociety.ca

Please it is important to include your name and email address in the information box on your e-transfer payment.
Should be Empty: