Membership Form – Cheque

Annual Membership Form - Cheque

"*" indicates required fields

Name*

Email*

Phone*

Group/Organization

Address*

Type of Membership*

All memberships are $10.00 each

Individual

Group, Agency or Organization

Business

Purpose*

New Membership

Membership Renewal

Total

Cheques are payable to:

Regina Open Door Society Inc.
Please mail to 2314 11th Avenue, Regina, SK, S4P 0K1,
Attention: Shelly Hill