MEMBERSHIP PAGE

SCAD MEMBERSHIP FORM 2010 - WEBSITE

Print off this form and mail with your cheque or money order to:

Address: Simcoe County Association of the Deaf

C/O Jim Campbell 7 Wynes Road Barrie, ON L4N 6T5

Name: _________________________________________________________________

Address: _______________________________________________________________

City/Prov.: ________________________________ Postal Code: ____________________

Phone: _____________________________ E-mail: ______________________________

Membership (January to December): [_] New [_] Renewal

Membership type:

[_] $25.00 Family [_] $20.00 Single (age 18 to 54) [_] $15.00 Senior Couple (age 55 over)

[_] $10.00 Student [_] $30.00 Company/Organization [_] $10.00 Senior Single (age 55 over)

Make Cheques or money orders payable to: Simcoe County Association of the Deaf

How would you like to receive your newsletter ?

[_] Email address (i.e. scadnews@gmail.com)

[_] Fax number (i.e. 705-555-5555)

[_] Mailed Home address (i.e. 123 Anystreet, Barrie, ON L4N 1A1)

Questions/Comments about this page, contact scad@scadbarrie.com