Membership Registration Form

CBRA Membership Application
CBRA Memberships are per-household.
I am paying: *

by Credit Card or PayPal by cheque to the "Cadboro Bay Residents Association": $15 for membership in the current year (posted separately)
I wish to pay for:
prev next ( X )
CBRA Membership (auto-renewed annually until cancelled) ( $ 12.00 CAD for each year )

CBRA Membership (one year only) ( $ 15.00 CAD one-time payment)

CBRA Membership and $20 donation (single) ( $ 35.00 CAD one-time payment)
I am *

renewing membership taking out membership for the first time
Full Name *

First Name Last Name
Spouse/Partner:

First Name Last Name
How many people in your household?
Email address: *
Membership includes automatic subscription to the Cadboro Bay News email bulletin. Is this acceptable, or do you prefer not to receive it?
Receive Newsletter by Email?

Yes, thanks No, thanks
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Comments
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CBRA Membership Application