Name:

Address:

Phone:

Email:

Would you like to receive our monthly newsletter? Yes   No
By email or regular post

Membership Fees:
1 Year Membership $20 Yes   No
I would like to sponsor a member for $20 Yes   No
I would like to sponsor half of a membership fee for $20 Yes   No
I would like to donate  to Citizens for Accessible Neighbourhoods

I am unable to afford a full membership but can afford

If you are unable to afford a membership you may be able to be sponsored by another member. Please let us know about your financial difficulties and we will try to assist you the best we can.

Please make cheques payable to: Citizens for Accessible Neighbourhoods

Forms may be mailed to: CAN, 11945 234 Street, Maple Ridge, BC, V2X 9M5.
Or you can bring your form to the next scheduled meeting.