membership form

The information contained within this form is being done so on a web site that is hosted outside of Canada. Nelson CARES Society is unable to confirm the security of this data and/or if this information is stored on this site and therefore outside the care, custody and control of Nelson CARES Society. Informed consent will be considered to have been given through the action of pressing the submit button. Should you not wish to submit this information electronically you are welcome to send this form via Canada Post or drop it by our office .

Nelson CARES Membership 2021-2022 Year

Sliding scale of $2.00 - $10.00

Date*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

The information contained within this form is being done so on a web site that is hosted outside of Canada. Nelson CARES Society is unable to confirm the security of this data and/or if this information is stored on this site and therefore outside the care, custody and control of Nelson CARES Society. Informed consent will be considered to have been given through the action of pressing the submit button. Should you not wish to submit this information electronically you are welcome to send this form via Canada Post or drop it by our office .

Phone*

Email*

Membership Fee amount*