Application Form

Family Name*

Given Name*

Date of Birth

Family Name

Given Name

Date of Birth

Address*

City*

Province*

Postal Code*

Home Phone*

E-mail: (optional)

Child’s Name

Date of Birth

Child’s Name

Date of Birth

Child’s Name

Date of Birth
Text Box: Annual Membership Fee Schedule

Please check the appropriate box

$35.00

$25.00

$20.00

$25.00

$20.00
Text Box: Make cheques payable to: “Alberta St. George of England Society” Mail to: Membership Secretary — 701-11503-100 Ave NW, Edmonton, AB. T5K 2K7 Text Box: Important: When submitting a cheque, please print this page and submit both.

Voluntary support is essential to the operations of the Society.

Please consider this and indicate an area of support that you may wish to consider now or later:

* Required fields