Membership Form
The Canadian Company of Pilgrims 2010
Please complete the following form
and submit it with a cheque payable to:
The Canadian Company of Pilgrims
P.O. Box 57004,
Ottawa, Ontario
K1R 1A1
Only one membership is required per household.
Individual memberships are required for separate addresses.
Please circle the appropriate choice: New Renewal
Name...........................................................................................................
Address......................................................................................................
City/Province/Postal Code.......................................................................
Country.......................................................................................................
E-mail address............................................................(circle here if new)
Phone(........)........-...................
Number of Memberships Required..........X $10 =..............
Number of Credentials Required..............X $ 5 =..............
Number of Badges Required.....................X $ 4 =..............
Total = $.....................
Names on Credentials.................................................................................
..................................................................................
..................................................................................
Date of Departure........................... |
Credentials are available to members only.
Please allow four weeks turn-around time.
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